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This study reports on the findings from a 6-year follow-up of a randomized trial of the Family Bereavement Program (FBP) on the outcomes for spousally bereaved parents. Spousally bereaved parents (N= 131) participated in the trial in which they were randomly assigned to receive the FBP (N= 72) or literature control (N= 59). Parents were assessed at four time points: pretest, posttest, and 11-month and 6-year follow-up. They reported on mental health problems, grief, and parenting at all four time periods. At the 6-year follow-up, parents reported on additional measures of persistent complex bereavement disorder, alcohol abuse problems, and coping efficacy. Bereaved parents in the FBP as compared to those in the literature control had lower levels of symptoms of depression, general psychiatric distress, prolonged grief, and alcohol problems, and higher coping efficacy (for mothers) at the 6-year follow-up. Multiple characteristics of the parent (e.g., gender, age, and baseline mental health problems) and of the spousal death (e.g., cause of death) were tested as moderators of program effects on each outcome, but only 3 of 45 tests of moderation were significant. Latent growth modeling found that the effects of the FBP on depression, psychiatric distress, and grief occurred immediately following program participation and were maintained over 6 years. Mediation analysis found that improvement in positive parenting partially mediated program effects to reduce depression and psychiatric distress, but had an indirect effect to higher levels of grief at the 6-year follow-up. Mediation analysis also found that improved parenting at the 6-year follow-up was partially mediated by program effects to reduce depression and that program effects to increase coping efficacy at the 6-year follow-up was partially mediated through reduced depression and grief and improved parenting. FBP reduced mental health problems, prolonged grief, and alcohol abuse, and increased coping efficacy of spousally bereaved parents 6 years later. Mediation pathways for program effects differed across outcomes at the 6-year follow-up.

This paper presents findings concerning the long-term effects of the Family Bereavement Program (FBP) to reduce suicide ideation and/or attempts of parentally bereaved children and adolescents. Parental death is a significant risk factor for suicide among offspring (Guldin et al., 2015). The study is a long-term follow-up of 244 children and adolescents who had participated in a randomized trial of the FBP, examining the intervention effects on suicide ideation and/or attempts as assessed through multiple sources. Results indicated a significant effect of the FBP to reduce suicide ideation and/or attempts at the six- and fifteen- year follow-up evaluation. The findings support the potential benefits of further research on “upstream” suicide prevention.

We investigated whether three self-system beliefs -- fear of abandonment, coping efficacy, and self-esteem -- mediated the relations between stressors and caregiver-child relationship quality and parentally bereaved youths’ general grief and intrusive grief thoughts. Cross-sectional (n=340 youth) and longitudinal (n=100 youth) models were tested. In the cross-sectional model, fear of abandonment mediated the effects of stressors and relationship quality on both measures of grief and coping efficacy mediated the path from relationship quality to general grief. Fear of abandonment showed a marginal prospective mediational relation between stressors and intrusive grief thoughts. After excluding the mediators, relationship quality showed a direct prospective relation to intrusive grief thoughts.

Parental death is one of the most traumatic events that can occur in childhood, and several reviews of the literature have found that the death of a parent places children at risk for a number of negative outcomes. This article describes the knowledge base regarding both empirically-supported, malleable factors that have been shown to contribute to or protect children from mental health problems following the death of a parent and evidence-based practices to change these factors. In addition, nonmealleable factors clinicians should consider when providing services for children who have experienced the death of a parent are reviewed.

Using a contextual resilience framework, the authors examine the processes whereby bereaved persons change over time. Rather than the concept recovery, the authors propose that the concept adaptation best captures the process of change following bereavement and that the desired outcome of such adaptation is denoted by the term resilience. Adaptation occurs over time and is shaped by environmental and individual level risk and protective factors. By use of a “contextual resilience” framework, the authors emphasize the central role that person–environment transactions play versus the heavy emphasis on intrapersonal processes in some other approaches to resilience.

Background The death of a parent is a major family disruption that can place children at risk for later depression and other mental health problems. Design Theoretically based randomized controlled trial for parentally bereaved children. Setting/Participants Two-hundred and forty-four children and adolescents and their caregivers from 156 families were randomly assigned to the Family Bereavement Program (FBP) intervention condition (90 families; 135 children) or to a control condition (66 families; 109 children). Data collection occurred from 1996 to 1998. Intervention Children and caregivers in the intervention condition met separately for 12 two-hour weekly sessions. Skills targeted by the program for children included positive coping, stress appraisals, control beliefs, and self-esteem. The caregiver program targeted caregiver mental health, life stressors, and improved discipline in the home. Both child and caregiver programs focused on improved quality of the caregiver–child relationship. Main Outcome Measures Child and caregiver reports of internalizing and externalizing symptoms. Results Longitudinal growth curve modeling was performed to model symptoms over time from the point of parental death. The rate of recovery for girls in the program condition was significantly different from that of girls in the control condition across all outcomes. Boys in both conditions showed reduced symptoms over time. Conclusions The methodology offers a conceptually unique way of assessing recovery in terms of reduced mental health problems over time after an event and has contributed to further understanding of FBP intervention effects. The intervention program facilitated recovery among girls, who did not show reduction in behavior problems without the program, while boys demonstrated decreased symptoms even without intervention.

This study presents an analysis of mediation of the effects of the Family Bereavement Program (FBP) to improve mental health outcomes of girls at 11 months following program participation. The FBP was designed based on a theory that program-induced change in multiple child and family level mediators would lead to reductions in children's mental health problems. Mediational models were tested using a three wave and a two wave longitudinal design. Using a three wave longitudinal design, FBP effects on three variables at T2 (increased positive parenting, decreased negative events, and decreased inhibition of emotional expression) were found to mediate the effects of the FBP on mental health problems at 11-month follow-up. Using a two-wave longitudinal design, support was found for FBP effects on three additional variables at 11-month follow-up (increased positive coping, decreased negative thoughts about stressors, and decreased unknown control beliefs) to mediate program effects to reduce mental health problems at 11-month follow-up. The discussion focuses on theoretical explanations for the mediational effects and on implications for identifying "core components" of the FBP that are responsible for its effects to reduce mental health problems of girls.

Investigated whether three self-system beliefs, fear of abandonment, coping efficacy, and self-esteem, mediated the relations of stressors and caregiver-child relationship quality with concurrent and prospective internalizing and externalizing problems in a sample of children who had experienced parental death in the previous 2.5 years. The cross-sectional sample consisted of 340 children ages 7-16 and their surviving parent/current caregiver; the longitudinal analyses employed a subset of this sample that consisted of 100 children and their parents/caregivers who were assessed at three time points. A multirater, multimethod measure of caregiver-child relationship quality and a multirater measure of children's mental health problems were used. The cross-sectional model supported a mediational relation for fear of abandonment, coping efficacy, and self-esteem. The three-wave longitudinal model showed that fear of abandonment at Time 2 mediated the relation between stressors at Time 1 and internalizing and externalizing problems at Time 3. Implications of these findings for understanding the development of mental health problems in parentally bereaved children and designing interventions for this at-risk group are discussed.

This study investigated a positive parenting composite of multiple measures of warmth and consistent discipline as a mediator of the relations between surviving parents' psychological distress and parentally bereaved children's mental health problems using both cross-sectional and prospective longitudinal models. The study included 214 bereaved children ages 7 to 16 and their surviving parent or current caregiver. A multirater, multimethod measurement model of positive parenting was developed. Although the mediational model was supported by analysis of the cross-sectional data, it was not supported in the 3-wave longitudinal model. However, the longitudinal model did find a significant path from positive parenting at Wave 2 to child mental health problems 11 months later at Wave 3, controlling for stability in child mental health problems. Implications for understanding the development of mental health problems of parentally bereaved children are discussed.

This study examined environmental stress, family, and child variables that differentiate resilient children and adolescents from those with mental health problems following the death of a primary caregiver. The community-based sample included 179 bereaved children ages 8 to 16 years and their surviving caregivers who completed a test battery of measures before participating in a prevention program. Forty-four percent of bereaved children were classified as resilient and 56% as affected based on the absence of clinically significant mental health problems on at least 1 measure as reported by either the child, surviving caregiver, or teacher on standardized measures of mental health problems. Results of multivariate analyses indicated that bereaved resilient versus affected status was a function of both family and child variables. Higher levels of caregiver warmth and discipline and lower levels of caregiver mental health problems were family-level variables that significantly differentiated resilient children from affected children. Bereaved children's perceptions of less threat in response to negative events and greater personal efficacy in coping with stress were child-level variables that differentiated resilient from affected status. Family and child variables were entered into a discriminant function analysis that correctly classified 72% of the sample. The findings are consistent with a model of resilience in which multilevel variables account for children's positive adaptation following exposure to adversity.

Parentally bereaved children's locus of control and self-esteem were examined as stress-moderators or stress-mediators of their internalizing and externalizing mental health problems. Seventy-six children ages 8 to 16 and their surviving parent were assessed 4 to 34 months after the death. Stress, locus of control, and self-esteem were measured by child report questionnaires. Internalizing and externalizing mental health problems were measured by child report on both questionnaires and a structured interview and by parent report questionnaires. The results revealed that self-esteem was a significant mediator of the relations between stress and both child and parent reports of internalizing problems but not externalizing problems. No significant mediation effects were found for locus of control. Neither locus of control nor self-esteem was a significant moderator of the relations between stress and children's internalizing and externalizing problems. Implications for understanding parentally bereaved children's mental health problems and for developing preventive interventions are discussed.

This article presents an experimental evaluation of the Family Bereavement Program (FBP), a 2-component group intervention for parentally bereaved children ages 8-16. The program involved separate groups for caregivers, adolescents, and children, which were designed to change potentially modifiable risk and protective factors for bereaved children. The evaluation involved random assignment of 156 families (244 children and adolescents) to the FBP or a self-study condition. Families participated in assessments at pretest, posttest, and 11-month follow-up. Results indicated that the FBP led to improved parenting, coping, and caregiver mental health and to reductions in stressful events at posttest. At follow-up, the FBP led to reduced internalizing and externalizing problems, but only for girls and those who had higher problem scores at baseline.

This article describes a preventive intervention to promote resilience of parentally bereaved youth. This intervention includes separate but concurrent programs for youth and caregivers that were developed to change empirically-supported risk and protective factors. We first discuss the risk that parental death confers to youth mental health and social adaptation outcomes. Next, we discuss the theoretical framework underlying this program. After describing the content and structure of the program, we describe the results of an experimental field trial and discuss directions for future work.

This paper describes a research-based program designed to promote resilience of parentally-bereaved children and their bereaved surviving parent. A contextual resilience model is described as the conceptual foundation of the program. The program is designed to enhance specific parenting and coping skills and to help caregivers and children accomplish goals they set for themselves at the outset of the program. The content of the twelve-sessions and the approach to teaching and supporting parents work on their program and personal goals are described. Evaluation of the program using a randomized experimental design indicates that the program is effective in promoting resilient outcomes of children and of the bereaved parent six-years following their participation in the program.

Evaluated an experimental preventive intervention developed for children who perceived their parents as problem drinkers. The 8-session program was designed to improve children's coping, self-esteem, and social competence, and modify alcohol expectancies which were specified as mediators of the effects of parental alcohol abuse on child mental health. Participants were 271 self-selected 4th-, 5th-, and 6th-grade students in 13 schools. The children were randomly assigned to treatment or delayed treatment conditions and the program was given to three successive cohorts of students. A meta-analysis across three different cohorts indicated significant program effects to improve knowledge of the program content and the use of support- and emotion-focused coping behaviors for the full sample. A slightly stronger range of effects was found for a high-risk subsample.

This study tested the effect of the Family Bereavement Program (FBP), a preventive intervention for bereaved families, on effective parenting (e.g., caregiver warmth, consistent discipline) 6 years after program completion. Families (n = 101; 69% female caregivers; 77% Caucasian, 11% Hispanic) with children between ages 8 and 16 who had experienced the death of one parent were randomized to the FBP (n = 54) or a literature control condition (n = 47). Multiple regression analyses conducted within a multilevel framework indicated that the FBP had a significant positive impact on a multirater, multimeasure assessment of parenting at 6-year follow-up, controlling for pretest levels of parenting and child mental health problems. Mediation analyses showed that short-term program effects on parenting, including caregiver warmth and effective discipline, significantly mediated the impact of the FBP on effective parenting 6 years later. These findings indicate that a relatively cost-effective brief intervention for families who experienced a major stressor resulted in sustained effects on caregiver warmth and consistent discipline 6 years following the program.

Approximately 3.4% of youth in the U.S. experience parental death.1 Research has found that parental death increases children’s short-term and long-term risk for mental health problems and their parents’ risk for depression3. Given these negative outcomes, the development of effective preventive interventions has high public health significance. However, there is no empirical support from randomized trials for the efficacy of programs for parentally-bereaved children. A recent meta-analysis of 13 controlled trials found a non-significant overall effect size.4 Further, no studies assessed program effects longer than one year after program completion and few studies have addressed sub-group differences in benefits, issues of critical importance for prevention research5. Although several reviews have proposed that only survivors of traumatic deaths and those with elevated levels of symptoms would benefit,4,6 there is limited evidence on this issue for bereaved youth. This study presents findings from a six-year follow-up of a randomized experimental trial of the Family Bereavement Program (FBP), a brief dual-component intervention designed to improve outcomes for bereaved youth and their parents. The FBP was designed to prevent negative outcomes by changing multiple, empirically-supported risk and protective factors.7 The FBP demonstrated significant benefits at 11-month follow-up to reduce mental health problems for girls and youth with greater mental health problems at program entry8, and significantly reduced caregiver mental health problems at post-test. It was hypothesized that at the six-year follow-up, the FBP as compared to a literature control (LC) would lead to lower prevalence of mental disorder, lower levels of mental health problems and higher levels of positive developmental outcomes of youth as well as reduce mental health problems of their spousally-bereaved parents. Although there is no evidence that bereaved children are at elevated risk for high risk sexual behavior and substance use, we examined these as secondary outcomes because of their developmental significance. Based on the findings from at the FBP8 and a meta-analysis of interventions for the bereaved9 we hypothesized that the benefits would be greater for those with higher initial levels of mental health problems, females, and those whose parent experienced a violent death. We also explored whether the FBP had differential effects across youth age.

Four putative mediators underlying gender differences in youths’ recovery from bereavement-related internalizing problems were examined in a sample (N = 109; age range of 8 to 16 years at the initial assessment) of parentally-bereaved youth: intrusive thoughts about grief, post-death stressors, negative appraisals of post-death stressors and fear of abandonment. A three-wave parallel process longitudinal growth model design was employed. Changes in internalizing problems and mediators were measured as a function of months since the death. Girls showed stability in depression symptoms and a slight rise in anxiety symptoms; boys’ trajectories of symptoms of anxiety and depression declined. Girls’ higher initial levels of post-death stressors, threat appraisals and fear of abandonment mediated their higher level of internalizing problems 14 months later. Girls’ higher initial fear of abandonment also mediated additional growth in anxiety relative to boys.

Positive parenting was examined as a protective resource against the adverse effects of negative life events on parentally bereaved children's mental health problems. The sample consisted of 313 recently bereaved children ages 8 to 16 and their current caregiver. Both the compensatory (direct effect independent of negative life events) and the stress-buffer (interactive effect with negative life events) protective resource models were examined and child gender was explored as a moderator of both models. Results revealed evidence for the compensatory protective resource model for both child and caregiver reports of mental health problems. No evidence of the stress-buffer model or child gender as a moderator was found. Implications for the understanding of children's responses to the death of a parent and the development and implementation of preventive interventions are discussed.

IRWIN SANDLER, Ph.D., TIM AYERS, Ph.D., AND SHARLENE WOLCHIK, Ph.D., of the Prevention Research Center at Arizona State University in Tempe, Arizona have designed and run a randomized experimental trial to evaluate the Family Bereavement Program, an intervention for parentally bereaved children and the surviving parent. The program is derived from clinical observations and research showing that loss of a parent is a highly stressful event, which can lead to future mental health problems in the child. Specifically, these researchers note that the death of a parent can lead to further family stressors, which may increase mental health problems of the surviving parent and have a negative effect on the parenting received by the child. This education and support program is designed to build coping skills within children themselves and to promote the parent’s use of healthy and effective parenting skills. For children, the intervention aims to teach problem solving and emotional regulation skills to help them recognize and deal with their feelings as well as the stressful situations that can follow the death of a parent. For parents, the targeted parenting skills include fostering a warm and responsive relationship with the child, maintaining positive routines, and using effective discipline. To achieve these goals, the researchers designed separate courses for parents, children, and adolescents, which take place over twelve consecutive weeks. These sessions include group “homework” so that all family members are developing and practicing dovetailed skills. Sandler, Ayers, and Wolchik report their findings from the experimental evaluation of this group intervention elsewhere.1 Here they focus on the details of what they did, barriers they faced and strategies for overcoming them, as well as how the Family Bereavement Program might be adapted to other nonexperimental settings. What follows are the edited comments from two interviews with Irwin N. Sandler, Ph.D., and Tim S. Ayers, Ph.D., conducted by Innovations Associate Editor Anna L. Romer, Ed.D. This article is excerpted from a thematic issue, “Coping with Loss,” Volume 3, Number 6, 2001 of the online journal Innovations in End-of-Life Care at ,www.edc.org/lastacts.. The online issue includes several excerpts from their training manual, which can be downloaded.

OBJECTIVE: To examine levels of violence exposure and reports of feeling unsafe in relation to psychological and behavioral characteristics for a general population sample of youths from an urban setting. METHOD: A comprehensive survey of high-risk behaviors, attitudes, indicators of adaptive behavior, and daily involvements was administered to a sample of 2,248 students in the 6th, 8th, and 10th grades in an urban public school system. RESULTS: More than 40% of the youths surveyed reported exposure to a shooting or stabbing in the past year, and 74% reported feeling unsafe in one or more common environmental contexts. Multiple regression analyses indicated significant relationships between violence exposure/feeling unsafe and a set of indicators of psychological and behavioral adaptation and expressed attitudes. CONCLUSIONS: These results attest to the picture of violence as a common fact of inner-city life and to the demand that is placed on urban youths to accommodate in their psychological development to chronic threat and lack of safety. VioLit summary: OBJECTIVE: The aim of the study by Schwab-Stone et al. was to investigate the psychological and behavioral characteristics of urban youth in relation to violence exposure and feelings of safety. METHODOLOGY: The authors conducted a quasi-experimental, cross-sectional analysis of data collected from 2,248 6th, 8th and 10th grade students attending urban district schools. The ethnic composition of the sample consisted of African-American, Hispanic and Caucasian students. The authors reported that 54.8% of the sample were female. 53.9% of the students lived in two parent households, 39.4% lived with one parent. The authors stated that a survey was administered by research or school personnel to students attending 142 classes at the 17 participating schools. The authors utilized the Social and Health Assessment measure (Weissberg et al., 1991), a 182 item instrument designed to measure middle and high school students' high risk behaviors, and positive community and school interests. The authors utilized survey items that addressed students' exposure to violence, feelings of safety, and the association between these factors and various measures of school and psychological functioning. Indicators of risk included an item that addressed violence exposure; "During the past year how many times have you seen someone get shot or stabbed?" Frequency of violence exposure was measured using a five point likert scale. Three groups of exposure levels were derived. These included no exposure, moderate exposure and high exposure. Feelings of safety were measured by assessing four spheres of student life. These included: "I feel safe in my home"; "...in my neighborhood"; "...at my school"; "...on the school bus or while walking to school." The authors organized three categories of feelings of safety according to the number of contexts in which respondents said they felt unsafe. The three categories consisted of those feeling safe in all four contexts, those feeling unsafe in one or two contexts and those feeling unsafe in three or four of the environments. Student attitudes were measured along three dimensions. These included "Willingness to use physical aggression" if respondent had been insulted, had an insulted family member, had something stolen and had been hit. Four items from the National Adolescent Student Health Survey (American School Health Association, 1990) were utilized. Cronbach's alpha was .76. "Diminished Perception of Risk Taking" addressed how much students believed that others their age would risk harming themselves. Criteria included substance use, carrying guns, fighting, ditching school, and other similar criteria. Four items were taken from the Monitoring the Future Scale (Johnston et al., 1990) and six items were developed by the authors. Likert scale format was utilized and ranged from 1 = no risk, to 4 = great risk. Cronbach's alpha was .85. Expectations about the future were assessed using 5 of 10 items from Jessor's Expectations of Goal Attainment Scale (Jessor et al., 1989). Items included "What are the chances that you will graduate from high school?"; "...that you will go to college?"; "...that you will have a job that pays well?"; "...will have a happy family life; and "...will stay in good health most of the time?" Cronbach's alpha was .76. Adaptation was measured along four dimensions. Depressed mood and anxiety was assessed with items adapted from a survey by Jessor et al. (1989). They included: "Have you just felt really down about things?"; "...depressed about life in general?"; and "Have you spent a lot of time worrying about little things?" A four point scale ranged from 1 = not at all, to 4 = a lot. Cronbach's alpha was .74. A seven item scale was developed based on Jessor's Delinquent-Type Behavior scale (three items) (Jessor et al., 1989), the National Adolescent Student Health Survey (one item) (American School Health Association, 1990) and the Youth Risk Behavior Survey (one item) (Centers for Disease Control, 1991) to measure aggression and antisocial activities (e.g., fighting, arrest, vandalism, theft, carrying a gun). Cronbach's alpha was .76. Frequency and type of alcohol used over the previous 30 days were assessed using a four item scale obtained from the Monitoring the Future Scale (Johnston et al., 1990). Cronbach's alpha was .82. Two items measured academic achievement; one asked if a grade had been repeated, the other asked for grade status. Respondents' mean z scores served as a measure of school achievement. The authors conducted chi square analyses, one-way ANOVAS, and multiple hierarchical regression analyses to evaluate the data. FINDINGS/DISCUSSION: The authors found that 41.3% of students reported that they had seen one or more shootings or stabbings in the past year. Males reported significantly greater violence exposure than females F(1,2199)=25.68, p In conclusion the authors stated that, overall, exposure to violence and feeling unsafe accounted for a large proportion of the variance in predicting aggressive/antisocial involvement. The authors reported that violence exposure was a high predictor of four aspects of social and personal adjustment. Depressed/anxious mood, aggressive/antisocial behavior and lower academic achievement were all significantly associated with feeling unsafe. AUTHORS' RECOMMENDATIONS: The authors suggested that the collection of future data on psychological and behavioral outcomes of violence exposure will enable a more thorough examination of its effects on feeling unsafe. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) Child Witness Juvenile Witness Exposure to Violence Community Violence Effects Witnessing Community Violence Witnessing Violence Effects Community Violence Effects Child Adjustment Juvenile Adjustment Elementary School Student Grade 6 Grade 8 Grade 10 Junior High School Student Senior High School Student Early Adolescence Late Adolescence Late Childhood Urban Youth Urban Environment Urban Violence Psychological Victimization Effects Language: en