ABSTRACT
The study was an evaluation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al. 2017) with child-caregiver dyads who experienced the death of a loved one from terrorism, using a hybrid efficacy/effectiveness design in which there were no required minimum symptom levels. Forty children ages 4-17 years old whose fathers died in the line of duty on 9/11/2001 and their mothers participated in an RCT comparing TF-CBT and Client-Centered Therapy (CCT). At baseline, mothers' PTSD, depression, and prolonged grief symptoms were highly elevated, whereas children's were at normative levels. Using intent-to-treat analysis, condition-by-time interactions showed significantly greater symptom reduction for mothers receiving CBT than those receiving CCT. For the children, both treatments led to significant symptom improvements.
ABSTRACT
Interventions for bereaved children and families range from supportive counseling, designed to promote social connectedness and expression of feelings and thoughts about the deceased, to intensive trauma/grief-specific therapy, designed to ameliorate symptoms of posttraumatic stress disorder (PTSD) and depression. That said, professionals have few brief assessment instruments to match response and functioning to appropriate interventions. To expedite the screening and referral process for bereaved families, Brown, Goodman, and Swiecicki ( 2008 ) developed the PTSD and Depression Screener for Bereaved Youth, a 19-item measure of bereavement-related history and symptoms of PTSD and depression. The current study is a psychometric evaluation of the Screener for Bereaved Youth. Data were collected from 284 bereaved children, 6-17 years of age (M = 12.4; SD = 2.9). A factor analysis revealed distinct subscales for PTSD (eight items) and depression (four items). The PTSD and depression subscales showed both concurrent and discriminant validity. Endorsement of four items on either subscale was associated with meeting full criteria on more extensive measures of PTSD and depression. These findings are discussed with specific consideration to the multiple systems in which the measure could be used and applications to clinical services.
Subject(s)
Bereavement , Depression/diagnosis , Psychiatric Status Rating Scales , Stress Disorders, Post-Traumatic/diagnosis , Adolescent , Child , Depression/complications , Female , Humans , Male , Psychiatric Status Rating Scales/standards , Psychometrics , Self Report , Stress Disorders, Post-Traumatic/complicationsABSTRACT
The objective of the present study is to determine if a brief measure of coping strategies administered to children and adolescents after a mass traumatic event - Youth Coping In Traumatic Times (YCITT) - has a factor structure similar to that of a lengthier, widely used scale, the How I Coped Under Pressure Scale (HICUPS). The YCITT was developed for the New York City - Board of Education WTC Study, conducted 6 months after 9/11. Confirmatory Factor Analyses (CFA) and Exploratory Factor Analysis (EFA) were performed in two randomly selected sub-samples of youth in grades 6-12 (sub-sample 1, n=2249; sub-sample 2, n=2315). In sub-sample 1, CFA indicated acceptable fit of a four-factor solution based on the HICUPS (distraction, active coping, support seeking and avoidance) and EFA yielded a nearly identical solution. In sub-sample 2, CFA indicated that the fit of the HICUPS-based factor solution and the solution derived from the EFA in sub-sample 1 were very similar, with both indicating acceptable model fit. In conclusion, the brief YCITT has a factor structure, which is similar to that of the HICUPS. When used in large-scale assessments of future mass traumatic events, the measure can provide relevant information about youth coping strategies across four key coping domains.
Subject(s)
Adaptation, Psychological , Life Change Events , Adolescent , Chi-Square Distribution , Child , Disasters , Factor Analysis, Statistical , Female , Humans , Male , New York City , Psychiatric Status Rating Scales , Psychometrics , September 11 Terrorist Attacks/psychology , Surveys and Questionnaires , Young AdultABSTRACT
This study evaluated the construct of childhood traumatic grief (CTG) and its correlates through a multi-site assessment of 132 bereaved children and adolescents. Youth completed a new measure of the characteristics, attributions, and reactions to exposure to death (CARED), as well as measures of CTG, posttraumatic stress disorder (PTSD), depression, and anger. CTG was distinct from but highly correlated with PTSD, depression, and, to a lesser degree, anger. In contrast to a recent study of complicated grief, CTG severity was significantly associated with the degree to which the death was viewed as traumatic. CTG was also associated with caregivers' emotional reaction at the time of the death and caregivers' current sadness. Clinical implications and recommendations for future research are discussed.
Subject(s)
Adaptation, Psychological , Attitude to Death , Death , Depression/psychology , Grief , Stress Disorders, Post-Traumatic/psychology , Wounds and Injuries/psychology , Adolescent , Anger , Caregivers/psychology , Child , Depression/etiology , Humans , Life Change Events , Qualitative Research , Risk Factors , Stress Disorders, Post-Traumatic/etiology , United States , Wounds and Injuries/complicationsABSTRACT
September 11, 2001 was a tragedy unparalleled in the United States, resulting in the largest number of parentally bereaved children from a single terrorist incident. The event necessitated swift and sensitive development of programs to meet the needs of bereaved children and their families, and it offered a rare opportunity to investigate the symptoms of, and intervention for, traumatic bereavement. Progress is being made in evaluating assessment and treatment services for traumatically bereaved children and their caregivers. However, attention must be paid to how programs are created in order to carry out the work. This article reports on the methods used to develop and deliver a clinical research program in the aftermath of 9/11. The specific challenges following a crisis, the decision-making process and lessons learned are highlighted, and future program development recommendations are presented.
Subject(s)
Bereavement , Family/psychology , Mental Health Services/supply & distribution , Program Development , Psychology, Child , Research Design , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/psychology , Adaptation, Psychological , Caregivers , Child , Decision Making , Humans , Life Change Events , New York , Police , United StatesSubject(s)
Child Development , Education , Social Adjustment , Adolescent , Child , Child, Preschool , Humans , Professional-Family Relations , TeachingABSTRACT
This study is an exploration of the measurement and correlates of childhood traumatic grief (CTG). Eighty-three children of uniformed service personnel who died during the World Trade Center attack on September 11, 2001, were assessed using measures of demographic characteristics, trauma exposure (physical proximity, emotional proximity, and secondary adversities), use of coping strategies, psychiatric symptoms (posttraumatic stress disorder [PTSD], general anxiety, depression), self-esteem, and traumatic grief. An exploratory factor analysis of the Extended Grief Inventory (EGI; Layne, Savjak, Saltzman, & Pynoos, 2001) indicated distinct constructs of normal versus traumatic grief. CTG factor scores were correlated with secondary adversities from the traumatic event, symptoms of PTSD, anxiety, depression, and coping responses, underscoring the theoretical and clinical utility of the content of the measure. Study limitations and future research recommendations are discussed.
Subject(s)
Depression/etiology , Depression/psychology , Grief , September 11 Terrorist Attacks/psychology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Wounds and Injuries/psychology , Adaptation, Psychological , Adolescent , Adult , Aircraft , Child , Child, Preschool , Female , Humans , Life Change Events , Male , New York City , Parent-Child RelationsABSTRACT
The term childhood traumatic grief (CTG) is being increasingly used to refer to the particular reaction in children that may follow the death of a loved one during a traumatic event. The goal of this case study is to describe the theoretical argument and framework for, as well as a clinical example of, cognitive-behavioral therapy (CBT) for CTG. We present a case of a five-year-old boy whose father, a firefighter, died in the line of duty at the World Trade Center on September 11, 2001. This specific case will highlight the steps of CBT for CTG, the value of assessment during the therapeutic process, and the need to consider developmental and family factors in treatment.
Subject(s)
Bereavement , Cognitive Behavioral Therapy/methods , Stress Disorders, Post-Traumatic/therapy , Terrorism/psychology , Adaptation, Psychological , Age Factors , Attitude to Death , Child , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Child, Preschool , Counseling , Depression/psychology , Family Therapy/methods , Fear/psychology , Fires/prevention & control , Grief , Homicide/psychology , Humans , Life Change Events , Male , New York City , Occupations , Psychiatric Status Rating Scales , Psychotherapeutic Processes , Stress Disorders, Post-Traumatic/psychologySubject(s)
Bereavement , Cognitive Behavioral Therapy , Person-Centered Psychotherapy , Stress Disorders, Post-Traumatic/therapy , Benchmarking , Boston , Child , Child Health Services , Child Reactive Disorders/psychology , Child Reactive Disorders/therapy , Community Health Planning , Community Mental Health Services/organization & administration , Crisis Intervention , Grief , Health Services Needs and Demand , Humans , Life Change Events , Organizational Case Studies , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/psychology , Stress, Psychological/therapy , Trauma Centers/organization & administration , Trauma Centers/standards , Treatment OutcomeABSTRACT
There has been increasing interest in the newly identified condition of childhood traumatic grief (CTG) since the 2001 attack on the World Trade Center. The case presented here is one of an adolescent girl who was diagnosed with CTG following the death of her father, a firefighter killed in the line of duty on September 11, 2001. Literature on CTG, its treatment, and adolescent development will be discussed. The application of client-centered treatment to CTG will be highlighted by the case description and diagnostic findings prior to, during, and following treatment.
