Supporting the Grieving Child and Family: Clinical Report.

The death of someone close to a child often has a profound and lifelong effect on the child and results in a range of both short- and long-term reactions. Pediatricians, within a patient-centered medical home, are in an excellent position to provide guidance to caregivers and to offer assistance and support to grieving children of all ages and their families. This clinical report offers practical suggestions on how to talk with grieving children to help them better understand what has happened and its implications. An understanding of guilt, shame, and other common reactions as well as an appreciation of the role of secondary losses and the unique challenges facing children in communities characterized by chronic trauma and cumulative loss will help the pediatrician to address factors that may impair children's adjustment and to identify complicated mourning and situations when professional counseling is indicated. Advice on how to support children's participation in funerals and other memorial services and to anticipate and address grief triggers and anniversary reactions is provided so that pediatricians are in a better position to advise caregivers and to offer consultation to and collaborate with professionals in schools, early education and child care facilities, and other child congregate care sites. Pediatricians often enter their profession out of a profound desire to minimize the suffering of children and may find it personally challenging to bear witness to the distress of children who are acutely grieving. The importance of professional preparation and self-care is, therefore, emphasized, and resources are recommended.

Mental Health Impact of Pandemics and Other Public Health Emergencies in Children.

Pediatric health care providers can provide universal support to children and families to mitigate potential risk factors to adjustment while fostering protective factors to promote resiliency in children and families. They can educate caregivers about ways to enhance recovery of their children by modifying expectations and addressing the special emotional and social needs of their children. Most public health emergencies evolve through stages across an extended time period, often taxing the personal resources of health care providers. This underscores the need for pediatric health care providers to integrate self-care strategies in their personal and professional practice routines.

Mediation of Parental Aggravation in the Association Between ADHD Severity and Electronic Media Use: A National Survey of Children's Health Study.

OBJECTIVE: To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation. METHODS: This was a retrospective analysis from the 2016 to 2017 National Survey of Children's Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD (n = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates. RESULTS: Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: ß = .02, p < .001; ß = .01, p = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents. CONCLUSION: These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD.

Educator Perspectives on Grief-Sensitive Training During the COVID-19 Pandemic in US Public Schools.

BACKGROUND: Grief and loss are common experiences for children and adolescents, particularly during the COVID-19 pandemic. Educators feel unprepared to support grieving students due to lack of training. We studied educator experiences receiving grief-sensitive training as part of the grief-sensitive schools initiative (GSSI), which provides grief-sensitive training, online video-based and print resources, and a financial grant to schools and school districts for use in supporting grieving students. METHODS: Fourteen New York and Florida educators who received GSSI training participated in small focus groups or semi-structured interviews on their experiences receiving GSSI training and supporting grieving students during the pandemic. Transcripts were analyzed using grounded-theory analysis. RESULTS: Emergent themes included increased confidence engaging grieving students, the desire for recurring trainings, the value of receiving training from an expert on pediatric grief and loss and the opportunity to ask questions, the need for grief-sensitive training to reflect the cultural diversity of school communities, the unique losses experienced by students during the pandemic, and compassion fatigue and burnout in educators. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Policymakers should recognize the effects of grief on students' learning and development and collaborate with educators to develop resources. CONCLUSIONS: Educators found GSSI training useful in supporting grieving students, particularly during the pandemic.

Hyperactivity and Impulsivity Symptoms Mediate the Association Between Adverse Childhood Experiences and Reading Achievement: A LONGSCAN Cohort Study.

Adverse Childhood Experiences (ACEs) include various childhood stressors that can negatively impact the health and well-being of children. ACEs are associated with poor academic achievement. Attention is strongly associated with academic achievement, and there is a graded relationship between ACEs exposure and subsequent development of parent-reported ADHD; however, it is unclear whether ADHD symptoms mediate the relationship between ACEs and academic achievement. This study tested a model of mediation by ADHD symptoms between ACEs and academic achievement (measured by reading score). This retrospective cohort analysis utilized data from the Longitudinal Study on Child Abuse and Neglect (LONGSCAN), a data consortium exploring the impact of child maltreatment (n = 494). There were relatively even numbers of male and female child participants, and the majority of caregivers were either non-Hispanic White or Black. Path analyses were modeled for ACEs as a sum score and separately for individual ACE exposures, with number of symptoms of Inattention (IN) and Hyperactivity/Impulsivity (H/I) as mediators, and academic achievement as the outcome, adjusting for covariates. ACEs were highly prevalent in this sample (M = 5.10, SD = 1.90). After retaining significant covariates, significant direct associations (P < .05) were seen between ACE sum score and IN (ß = .14) and H/I (ß = .21), and between H/I and reading score (ß=-.14). A higher ACE score was associated with lower reading scores through variation in H/I, but not IN. H/I mediated the relationship between ACEs and reading score in this high-risk population, providing new insight into relationships between ACEs and academic achievement, which can inform interventions.

Effect of home environment on academic achievement in child protective service-involved children: Results from the second national survey of child and adolescent well-being study.

BACKGROUND: Children involved with Child Protective Services (CPS) have been shown to have lower academic achievement. It is unclear whether certain qualities of the home environment can optimize academic achievement in this vulnerable population. OBJECTIVE: This study sought to determine whether home environments with higher levels of emotional support and cognitive stimulation predict later academic achievement and whether this relationship is moderated by placement type (i.e. biological/adoptive parent care, kinship care, or non-kinship foster care). PARTICIPANTS AND SETTING: This study included 1,206 children from the second National Survey of Child and Adolescent Well-Being (NSCAW-II) who were involved with CPS between 2-7 years of age. METHODS: Multivariate analyses were completed to examine the effect of the Home Observation for Measurement of the Environment (HOME) score on later Woodcock-Johnson III Tests of Achievement (WJ-ACH) scores. Moderation analyses were conducted to determine the effect of placement type on this relationship. RESULTS: Although these relationships between HOME scores and WJ-ACH scores were significant in bivariate analyses, they were not statistically significant in multivariate analyses, primarily due to the variable of household income. Although children placed primarily in non-kinship foster care demonstrated higher WJ-ACH scores for Passage Comprehension and Letter-Word Identification subscales, placement type did not appear to moderate the relationship between HOME scores and academic achievement. CONCLUSION: Child- and caregiver-level factors, as well as financial resources available in the environment, may account for the relationship between home environment and academic achievement.

Participation of Children and Adolescents in Live Crisis Drills and Exercises.

Children and adolescents should be included in exercises and drills to the extent that their involvement advances readiness to meet their unique needs in the event of a crisis and/or furthers their own preparedness or resiliency. However, there is also a need to be cautious about the potential psychological risks and other unintended consequences of directly involving children in live exercises and drills. These risks and consequences are especially a concern when children are deceived and led to believe there is an actual attack and not a drill and/or for high-intensity active shooter drills. High-intensity active shooter drills may involve the use of real weapons, gunfire or blanks, theatrical makeup to give a realistic image of blood or gunshot wounds, predatory and aggressive acting by the individual posing to be the shooter, or other means to simulate an actual attack, even when participants are aware that it is a drill. This policy statement outlines some of the considerations regarding the prevalent practice of live active shooter drills in schools, including the recommendations to eliminate children's involvement in high-intensity drills and exercises (with the possible exception of adolescent volunteers), prohibit deception in drills and exercises, and ensure appropriate accommodations during drills and exercises based on children's unique vulnerabilities.

Supporting Children After School Shootings.

Anticipatory guidance should be provided to families on identifying and addressing common adjustment reactions after a school shooting. Although adjustment difficulties may be related to post-traumatic and grief reactions, many will not be directly attributable to the school shooting. Understanding how to cope with associated worries and reactions can help children better adjust. Pediatricians can assist with guidance about the development of a reasonable timeline for emotional and academic recovery, traumatic stress/loss, coping strategies, support for students with special needs, identification of students most in need of support, identification of staff who are most likely impacted, and appropriate preparedness activities.

Extending the Reach of Pediatric Emergency Preparedness: A Virtual Tabletop Exercise Targeting Children's Needs.

OBJECTIVES: Virtual tabletop exercises (VTTXs) simulate disaster scenarios to help participants improve their emergency-planning capacity. The objectives of our study were to (1) evaluate the effectiveness of a VTTX in improving preparedness capabilities specific to children's needs among pediatricians and public health practitioners, (2) document follow-up actions, and (3) identify exercise strengths and weaknesses. METHODS: In February 2017, we conducted and evaluated a VTTX facilitated via videoconferencing among 26 pediatricians and public health practitioners from 4 states. Using a mixed-methods design, we assessed participants' knowledge and confidence to fulfill targeted federal preparedness capabilities immediately before and after the exercise. We also evaluated the degree to which participants made progress on actions through surveys 1 month (n = 14) and 6 months (n = 14) after the exercise. RESULTS: Participants reported a greater ability to identify their state's pediatric emergency preparedness strengths and weaknesses after the exercise (16 of 18) compared with before the exercise (10 of 18). We also observed increases in (1) knowledge of and confidence in performing most pediatric emergency preparedness capabilities and (2) most dimensions of interprofessional collaboration. From 1 month to 6 months after the exercise, participants (n = 14) self-reported making progress in increasing awareness for potential preparedness partners and in conducting similar pediatric exercises (from 4-7 for both). CONCLUSIONS: Participants viewed the VTTX positively and indicated increased pediatric emergency preparedness knowledge and confidence. Addressing barriers to improving local pediatric emergency preparedness-particularly long term-is an important target for future tabletop exercises.

The role of school psychologists in the support of grieving children.

School psychologists are in a unique position to both identify and work with grieving students; to provide guidance to schools, families, and peers on approaches to support such children and youth; and to offer training to classroom educators so that they are better prepared to support grieving students. Yet, there has been minimal research published on this topic in professional journals. This special section of School Psychology Quarterly is devoted to grief and loss with the hope of beginning to narrow this gap in the literature. The three articles in this special section add to an evolving evidence-base that grief in children is common and the impact can be profound, that school professionals can and should play a major role in supporting grieving children, and that school psychologists can play a key role in empowering classroom educators and other school professionals so that no child in the future has to grieve alone. (PsycINFO Database Record

Improving adjustment and resilience in children following a disaster: Addressing research challenges.

There is compelling evidence of the potential negative effects of disasters on children's adjustment and functioning. Although there is an increasing base of evidence supporting the effectiveness of some interventions for trauma following disaster, more research is needed, particularly on interventions that can be delivered in the early aftermath of disaster as well as those that can address a broader range of adjustment difficulties such as bereavement that may be experienced by children after a disaster. This article identifies gaps in the knowledge of how best to intervene with children following disasters. Key challenges in conducting research in disaster contexts, including obtaining consent, designing rigorous studies, and obtaining funding quickly enough to conduct the study, are discussed. Several strategies hold promise to address research challenges in disasters, including using alternative designs (e.g., propensity scores, matched control groups, group-level assignment), working with schools and communities, and studying implementation of nontraditional modes of intervention delivery. (PsycINFO Database Record

Addressing Children's Needs in Disasters: A Regional Pediatric Tabletop Exercise.

OBJECTIVE: Preparing and responding to the needs of children during public health emergencies continues to be challenging. The purpose of this study was to assess the usefulness of a tabletop exercise in initiating pediatric preparedness strategies and assessing the impact of the exercise on participants' understanding of and confidence in their roles during pediatric public health emergencies. METHODS: A tabletop exercise was developed to simulate a public health emergency scenario involving smallpox in a child, with subsequent spread to multiple states. During the exercise, participants discussed and developed communication, collaboration, and medical countermeasure strategies to enhance pediatric public health preparedness. Exercise evaluation was designed to assess participants' knowledge gained and level of confidence surrounding pediatric public health emergencies. RESULTS: In total, 22 participants identified over 100 communication and collaboration strategies to promote pediatric public health preparedness during the exercise and found that the most beneficial aspect during the exercise was the partnership between pediatricians and public health officials. Participants' knowledge and level of confidence surrounding a pediatric public health emergency increased after the exercise. CONCLUSION: The tabletop exercise was effective in identifying strategies to improve pediatric public health preparedness as well as enhancing participants' knowledge and confidence surrounding a potential pediatric public health emergency. (Disaster Med Public Health Preparedness. 2018;12:582-586).

A 9-Year-Old Girl Discovers That Her Mother Was Murdered.

CASE: Susan was a 9-year-old girl living with her mother; she had never met her father. Her mother returned one evening from her job as a cocktail waitress and Susan met her at the apartment door to let her know they had run out of cat food. Her mother said she would go and buy some the next morning because it was late and she was tired, but Susan insisted she go out that evening because the cat had not eaten all day. Her mother was fatally shot in the parking lot of the convenience store shortly thereafter; since there was no robbery involved, the police suspected it was someone that she knew. Susan's extended family had her move out of the apartment that evening and relocate to live with her aunt and uncle out-of-state. The transition happened quickly. Susan was unable to return to her apartment to pick up any additional belongings and never returned to say goodbye to her friends. The family decided she was too young to attend the funeral.Susan had trouble fitting in with her aunt and uncle's family; they had 2 children who were 8 and 6 years old, and Susan felt she was being treated like a baby. She resented having a bedtime (her mother allowed her to stay up as late as she wished), and she complained that the work at school was boring and her classmates were childish. When the family went to a festival in town, she left abruptly without telling them, which frightened Susan's aunt and uncle. They wanted to be supportive but felt that she needed more structure than her mother had provided her. Susan's aunt and uncle sought bereavement support for Susan from her pediatrician and parenting advice for themselves.

Supporting the Grieving Child and Family.

The death of someone close to a child often has a profound and lifelong effect on the child and results in a range of both short- and long-term reactions. Pediatricians, within a patient-centered medical home, are in an excellent position to provide anticipatory guidance to caregivers and to offer assistance and support to children and families who are grieving. This clinical report offers practical suggestions on how to talk with grieving children to help them better understand what has happened and its implications and to address any misinformation, misinterpretations, or misconceptions. An understanding of guilt, shame, and other common reactions, as well an appreciation of the role of secondary losses and the unique challenges facing children in communities characterized by chronic trauma and cumulative loss, will help the pediatrician to address factors that may impair grieving and children's adjustment and to identify complicated mourning and situations when professional counseling is indicated. Advice on how to support children's participation in funerals and other memorial services and to anticipate and address grief triggers and anniversary reactions is provided so that pediatricians are in a better position to advise caregivers and to offer consultation to schools, early education and child care facilities, and other child congregate care sites. Pediatricians often enter their profession out of a profound desire to minimize the suffering of children and may find it personally challenging when they find themselves in situations in which they are asked to bear witness to the distress of children who are acutely grieving. The importance of professional preparation and self-care is therefore emphasized, and resources are recommended.

A 9-Year-Old Girl Discovers That Her Mother Was Murdered.

CASE: Susan was a 9-year-old girl living with her mother; she had never met her father. Her mother returned one evening from her job as a cocktail waitress and Susan met her at the apartment door to let her know they had run out of cat food. Her mother said she would go and buy some the next morning because it was late and she was tired, but Susan insisted she go out that evening because the cat had not eaten all day. Her mother was fatally shot in the parking lot of the convenience store shortly thereafter; since there was no robbery involved, the police suspected it was someone that she knew. Susan's extended family had her move out of the apartment that evening and relocate to live with her aunt and uncle out-of-state. The transition happened quickly. Susan was unable to return to her apartment to pick up any additional belongings and never returned to say goodbye to her friends. The family decided she was too young to attend the funeral. Susan had trouble fitting in with her aunt and uncle's family; they had 2 children who were 8 and 6 years old, and Susan felt she was being treated like a baby. She resented having a bedtime (her mother allowed her to stay up as late as she wished), and she complained that the work at school was boring and her classmates were childish. When the family went to a festival in town, she left abruptly without telling them, which frightened Susan's aunt and uncle. They wanted to be supportive but felt that she needed more structure than her mother had provided her. Susan's aunt and uncle sought bereavement support for Susan from her pediatrician and parenting advice for themselves.

Providing Psychosocial Support to Children and Families in the Aftermath of Disasters and Crises.

Disasters have the potential to cause short- and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. This clinical report provides practical suggestions on how to identify common adjustment difficulties in children in the aftermath of a disaster and to promote effective coping strategies to mitigate the impact of the disaster as well as any associated bereavement and secondary stressors. This information can serve as a guide to pediatricians as they offer anticipatory guidance to families or consultation to schools, child care centers, and other child congregate care sites. Knowledge of risk factors for adjustment difficulties can serve as the basis for mental health triage. The importance of basic supportive services, psychological first aid, and professional self-care are discussed. Stress is intrinsic to many major life events that children and families face, including the experience of significant illness and its treatment. The information provided in this clinical report may, therefore, be relevant for a broad range of patient encounters, even outside the context of a disaster. Most pediatricians enter the profession because of a heartfelt desire to help children and families most in need. If adequately prepared and supported, pediatricians who are able to draw on their skills to assist children, families, and communities to recover after a disaster will find the work to be particularly rewarding.