Principal Investigator: Irwin N. Sandler
Level of Intervention: Selected
Target Population: Children who have experienced the death of a parent.
References: Sandler, West, Baca, Pillow, Gersten, Rogosch, Virdin, Beals, Reynolds, Kallgren, Tein, Kriege, Cole, & Ramirez (1992).
Theory (Risk & Protective Factors Targeted):
Research has shown that the stress associated with the death of loved one may result in withdrawn, anxious, and depressed responses in children (Felner, Ginter, Boike, & Cowen, 1981) and increased rates of psychiatric symptoms. The Family Berevement Program is based on a theoretical model in which certain factors are critical for the effect that bereavement of parental death has on psychological functioning. Mediators targeted by the intervention included parental demoralization, negative life events, parental warmth, and stable positive events in the family. The program was designed to improve the mediating factors identified in model and thus reduce psychological symptomatology in the child.
Description of Intervention:
The program included two major components: a family grief workshop (3 sessions) and a family advisor program (12 sessions). Some sessions were held with parents only, while others included the entire family. The family grief workshop connected bereaved families to each other, educated them on the nature of the grief process, and provided opportunities to share grief-related feelings. The sessions were also designed to improve communication and foster warmth in the relationship between the surviving parent and the child. The second phase of the program was a highly structured 12-session family advisor program that focused on changing the four mediators identified in the model (parental demoralization, parental warmth, stable positive events, and negative stress events). The family advisor utilized the supportive relationship of the leader with the family to teach relationship skills, increase positive exchanges within the family, and increase quality time that family members spent together. In addition, the family advisor facilitated the parents use of problem solving techniques to plan stable positive events, and to improve the families coping with stressful family events. The family advisors had a minimum of a B.S. degree and had personally experienced bereavement.
Subjects were recruited by sending letters to surviving spouses of individuals age 25-50 who had died within the prior 2 years. These individuals were identified through State Health Department Death Certificates and referrals through churches & mortuaries. Using the state records, 866 families were identified and 272 were contacted by phone. Of the 88 families that had a child in the required age range, 46 families agreed to participate. Twenty-six families were recruited by referrals. The final subject pool contained 72 families that were primarily from female-headed households and relatively homogeneous SES levels. The sample was 81.9% European-American, 2.7% African-American, 8.3% Hispanic, 1.4% Native-American, 1.4% Asian, and 4.2% other. The average age of the child participants was 12.39 and 51% were male.
Families were randomly assigned to immediate treatment (experimental) or a control group (6-month delayed treatment). If more than one child in the family was age 7 to 17, then one child was randomly selected to be the target child assessed. Families were asked to not participate in any other counseling programs during the experimental trial.
Chi square analyses indicated that there were no group differences in rates of attrition but Treatment Condition x Attrition interaction effects were found on two variables. Control subjects that dropped out of the study had significantly higher levels of education (p<.05) and discussed bereavement issues less (p<.05) than subjects who remained in the study.
A Treatment x Time x Age of Child effect was found on a composite variable reflecting overall adjustment (p<.05). The composite was created by standardizing and summing children scores on parent reports of depression and conduct problems derived from the Child Behavior Checklist (CBCL, Achenbach, 1991). Follow-up analyses revealed that older children (age 12-17) who participated in the program were rated as significantly less depressed (p<.05) and exhibited fewer conduct problems (p<.01) compared to older control children. Younger children (age 7-11) in the program were described as exhibiting significantly fewer conduct problems compared to controls (p<.01).
Significant treatment effects were found on a number of the mediating variables. The program significantly increased parental reports of warmth in the parent-child relationships (p<.05), as well as their satisfaction with their social support after participating in the intervention compared to controls (p<.01). Parents in the control group reported that they discussed grief-related feelings less frequently over time compared to the intervention group (p<.05). Parents of younger children who participated in the program also reported significantly fewer negative life events at the end of the treatment compared to controls (p<.01). Analyses were conducted with the sample of older children to test if whether the program effects were mediated by any of the variables proposed. Results indicated that parent reports of the warmth in the parent-child relationship mediated the program effects.
Strengths & Limitations:
The Family Bereavement Program is a program designed to prevent potential mental health complications (i.e. depressive symptomatology, conduct problems) in children that may result from the death of a parent. The programs targets the entire family and is designed to educate members about the grief process. It also creates a support network for families by connecting them with others who have experienced the same event and facilitates adaptive coping along four dimensions through the use of a family advisor who has also experienced significant bereavement. Results of a randomized clinical trial suggest that the program was effective in improving childrens adjustment (i.e. lower depressive symptoms and fewer conduct problems) according to the parents report. It is important to note that while there were changes in childrens symptoms according to parents, there were no treatment effects according to childrens reports. Extensive steps were taken to ensure the fidelity of the program implementation. The family advisors participated in extensive training and received on-going supervision. Manuals were used to guide both phases of the intervention and outlined specific activities for each session.