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Bereavement educators, counselors, clergy, and other specialists have observed that African Americans tend to under-utilize end-of-life palliative care services and general bereavement resources. The literature suggests that involving clergy in outreach to the African American community may be a viable strategy for developing bereavement supports. This paper looks at seven questions that can facilitate the process of engaging care and shares insights from a minister, two bereavement counselors, and two educators who are involved in church-based ministries with African Americans. The questions include: (1) what types of services are available in African American churches; (2) who can provide bereavement services; (3) when should they be offered; (4) where can they be provided; (5) how can they be instituted; (6) why is the church an important provider; and (7) what can a provider expect when taking on bereavement services. It suggests that it is important for counselors to develop skills to supplement and support the bereavement needs of the African American church as it seeks to broaden death and dying services to the community. (JDM)

This paper provides counselors and other helping professionals with tools for assessment of and intervention in grieving families that have suffered the loss of a child or fetus through illness, accident, violence, or miscarriage. Helping professionals who don't specialize in grief issues can especially benefit from this information, as many clients display unrecognized and/or unresolved grief issues. Several recommendations for assessment of grieving families are offered. Recommendations include evaluating the level of functioning of individual family members and the family system itself, assessing the levels of communication within and cohesion of the family, and assessing symptomology related to depression and bereavement. A systemic approach that emphasizes family, group, and school interventions is recommended to assist the family in positive grief resolution. (Contains 21 references.) (GCP)

African American pastors are increasingly becoming involved in the care and understanding of those infected with HIV and AIDS. In this pilot project, lay leaders of a Methodist Church in Queens, New York participated in a facilitator training program for AIDS bereavement. A variety of theoretical perspectives that included bereavement theory; group work; cultural diversity and empowerment practice; community theory; and adult learning theory were drawn upon to develop the program for facilitator training. The emphasis on training lay leaders from the church community offers an additional resource for community agencies. A survey was conducted to discover how the lay leaders responded to a structured training program run by a minister, a professor, and a social worker. Analysis indicated that the training met most of the didactic and emotional needs. However, lay leaders suggested that churches and other community organizations need to build and sustain guidance and educational efforts to prevent AIDS. (Contains 6 tables and 19 references.) (JDM)

A self-inventory for school psychologists to become cognizant of their own understanding of and feelings about disenfranchised grief is presented. In death-related behavior, grief is socially constructed. There are social standards that apply to expressing grief; however, there are times when "grieving rules" may not coincide with the situation, attachments, sense of loss, or feelings of the survivors. In these cases grief may be hidden. Four categories of disenfranchised grievers (disenfranchised relationships, disenfranchised losses, unrecognized or disenfranchised grievers, death not socially sanctioned) are discussed. When a loss is ambiguous and cannot be openly mourned, grief is disenfranchised and mourning becomes complicated. A process model for grief and recovery is reviewed. Guidelines for school psychology practice are provided under the final topic, "What Can School Psychologists Do?" Appendix A gives instructions for use of the "Disenfranchised Grief Self Inventory" are given with discussion of debriefing for psychologists. Appendix B presents Bronfenbrenner's ecological theory as it is used to further support the school psychologist in reaching out to unsupported grievers. Appendix C is a list of resources for supporting grievers. (Contains 21 references.) (EMK)

One of the techniques frequently recommended for bereaved children is participation in grief support groups through schools or community agencies. The Bereavement Directors of two hospices in northern Colorado were interested in learning more of the effectiveness of the children's' grief groups which they were conducting. The final design of the evaluation involved traditional pre- and post-test measures with a treatment group and a control group. Over a period of 18 months, 20 children (7-11 years old) and their families participated in the treatment group, which involved completion of the pre- and post-test measures and attendance at an 8-week grief support group. A total of 14 children and their families were in the control group. Measures used with the children were the Death Concept Scale and the Piers Harris Self-Concept Scale; parents were asked to complete an information questionnaire and a child behavior checklist. Both children and parents participated in semistructured interviews. Responses in general indicated that participation in the groups was effective and beneficial. Participant responses to questions regarding their experiences in the grief support groups are summarized. (TS)

Grief is a natural response to loss. Bereavement is a universal biopsychosocial phenomenon, yet each individual has unique ways of expressing their loss. This recognition raises the question as to when the range of symptoms are typical and require no therapeutic intervention and when psychotherapeutic intervention is indicated. At present no criteria based definition of complicated bereavement exists. This limits access to services, presents risks of misdiagnosis, and/or inappropriate treatment. This review of the literature provides definitions of uncomplicated and complicated bereavement; and explores commonly used diagnostic categories related to complications in bereavement. Differing perspectives regarding the tendency to utilize the diagnosis of Major Depressive Disorder (MDD) are highlighted. A separate diagnostic category for complicated bereavement is recommended. Contains 30 references. (JBJ)

In helping children cope with death, teachers must facilitate children's passing through the physiological and psychological processes of grieving. Standard protocols can be established in order to develop a range of possible crisis intervention methods. The teacher's first role in the moments of shock and confusion which follow a sudden death is to help children feel safe. The teacher should explain the situation in terms children can understand, and thus establish a basis for dialogue about the incident itself and about the emotions children are feeling. Three main tasks should be part of any crisis response: (1) acknowledging the event's reality; (2) establishing an environment in which children feel comfortable in talking about their feelings; and (3) providing appropriate curricular materials and learning opportunities so that children can comprehend what has happened. Teachers should (1) be good listeners, (2) share information about the event and about their own feelings openly, (3) answer children's questions truthfully, (4) reinforce children's understanding that death is a difficult thing with which to cope and that confusion and anxiety at times of death are normal, and (4) acknowledge that death is part of life. Contains 13 references. (JW)

Little research on death awareness (defined as the number of deaths experienced, frequency of thoughts about death, and awareness of a grief/mourning period) has been done and little is known about levels of awareness at different ages, though such knowledge would be valuable to bereavement counselors. Contrary to the hypothesis that college age students have a low level of death awareness, a survey of 64 college age students from a midwestern university revealed that they are moderately aware of death. The average number of deaths experienced was 5.16. The average number of students who reported thinking of their own death "once in awhile" was 81.3% and 76.6% remembered a period of mourning after a death, although most (73.3%) were unaware of any particular mourning process they had used in the past. Included is the survey. Contains 9 references. (Author/MSF)

A university health center has experienced an increase in the number of women undergoing elective abortion which resulted in their seeking counseling services to assist them in dealing with overwhelming feelings of guilt and grief. The loss of a pregnancy is often followed by a typical grief reaction that occurs after any bereavement. In working with a number of women who were experiencing post-abortion grief and guilt, the women indicated that their abortions were performed at a variety of public and private clinic settings. The settings were described as being highly medical in nature. An amalgamation and synthesis of the literature review led to the therapeutic concept with these women that the clinic in which their abortion occurred was now a "sacred site" because of their experiences there. Using the setting to help validate the loss, the women were recommended to re-visit the site of their abortions and sit outside the facility for 10-15 minutes so that they could re-live their experience and speak to their fetus/child. If they chose, they could leave something behind as an offering after they had time to reflect upon their experience. It is recommended that practicing therapists continue to develop creative approaches to ease any guilt/grief reactions caused in the aftermath of elective abortion, and more importantly for women to be there for each other. (ABL)

Childhood cancer and its treatment have been identified as significant stressors for individuals and families. The impact of this experience on healthy siblings has not been clearly determined. This study was designed to assess siblings regarding their adjustment and their perceptions of their families following a sick sibling's treatment. Standardized measures were used to facilitate comparisons. Siblings of children who survived cancer (n=25) were compared with siblings of children who died of cancer (n=24) so as to understand the complexities of the experience relative to treatment outcome. Subjects were 49 siblings, ranging in age from 10 to 20 years, and their parents. Results indicate that siblings reported levels of behavioral disturbance which did not significantly differ from those of a contrast group of children referred for psychological services. However, siblings did not differ significantly from a normative group in terms of self-image adjustment. Minimal adjustment differences were found between bereaved siblings and nonbereaved siblings with bereaved siblings reporting poorer adjustment only in the area of body image. Similarly, no significant gender effects on sibling adjustment were found. Results suggest a preponderance of similarity in adjustment for bereaved and nonbereaved siblings. (Author/RJM)

Studies of parents of children treated for cancer have rarely included adequate samples of fathers or couples. Further, bereaved parents have been over-represented as compared to parents of cancer survivors. This study investigated the personal and interpersonal effects of having a child treated for cancer on 124 parents. Twenty-seven married couples were bereaved and 33 married couples were nonbereaved. Four bereaved parents without spouses were also included. All survivors had been off-treatment for at least 6 months and the average time since diagnosis was 6 years. Effects at the personal level-psychological distress-were assessed by self-report on one global scale and 7 subscales of the Brief Symptom Inventory (BSI). Effects at the interpersonal level-marital satisfaction-were assessed by self-report on the summary scale and 2 factors of the Martial Adjustment Test. Mothers and fathers reported higher levels of psychological distress than nonpatient norms, but lower levels than outpatient psychiatric norms. Fathers reported lower levels of marital satisfaction than nonreferred male norms; mothers did not differ from norms on marital satisfaction. Matched pairs t-tests on 60 couples demonstrated no differences between mothers and fathers in terms of levels of psychological distress and marital satisfaction. Bereaved and nonbereaved mothers did not differ on reported levels of psychological distress after controlling for the effects of time since diagnosis. This time effect appeared to be more salient for mothers, with mothers of more recently diagnosed children reporting higher levels of distress. Bereaved fathers did report higher levels of psychological distress on several BSI subscales than did nonbereaved fathers; no effect of time since diagnosis was observed for fathers. After a median split into high and low on the distress dimension, bereaved mothers reporting higher psychological distress also reported lower satisfaction with their marriages. Fathers reporting higher levels of psychological distress also reported lower marital satisfaction, but this was true of both bereaved and nonbereaved fathers. The results reveal some areas of similarity in outcome for bereaved and nonbereaved parents and for mothers and fathers of children treated for cancer. There are suggestions, however, of differential processes for mothers and fathers in terms of the effects of time since diagnosis, treatment outcome, and personal distress on satisfaction with the marital relationship. The results are suggestive of the complexities of parental coping with childhood cancer and the need for greater specificity and continued study. (Author)

The adolescent suicide rate in the United States has tripled in the last 25 years. While suicides cause tremendous familial complications, this act also causes significant upheaval in the public school environment. The purpose of this paper is to offer an updated theoretical rationale as to why children and early adolescents are choosing suicide as their only option. A model for suicide postvention is also presented in which the school psychologist would play a prominent role in assessing student needs and assisting students in coping with the aftermath of suicide. It is hypothesized that baby boomer parents, in an effort to correct dysfunctional behaviors from their families of origin, have done two things that could lead to the increased adolescent suicides: (1) they cushioned or protected their child from failing at anything; and (2) they led the child to believe that he or she was "special," which increased the gap between reality and expectations when failure inevitably occurs. The goals of postvention are to help students, faculty, and staff with the grieving process and to prevent further suicides. It is recommended that someone from the crisis team, preferably the school psychologist, be assigned the responsibility to attend the class schedule of the decedent. (JBJ)

Phenomenological methods were used to explore the experience of grief after bereavement. Nine bereaved adults volunteered to participate in interviews in which they discussed their experience of grief after the death of a loved one. An analysis of the interviews revealed the following themes in the experience of grief after bereavement: Coping, Affect, Change, Relationship, and Details. (Contains 50 references and 1 figure.) (GCP)

Examines the psychological studies of bereavement support groups as well as exploring the ways in which people talk about their participation in such groups after their family member's suicide. This paper draws on a study of 16 interviews with bereaved parents and (adult) children, half of whom had attended a bereavement support group after their family member's suicide. (Contains 46 references.) (GCP)

This book is the third book of series and is dedicated to the children who lost fathers on September 11. It is a story of the bond between a father and his child--the love, the laughter, the loss, and finally, the learning to live without that very special person. (GCP)

This study looks at the influence of worldview on long-term survivors of loss and the subsequent identity these survivors assume years after the formal grieving process has occurred. Emphasis is placed on the perspective survivors develop over time. Information from nearly 80 survivors of childhood loss indicated that there are certain patterns in perception of time, values, priorities, and relationship to the world that lead to development of a new identity. The identity types are based on response patterns that emerged from five psychological and spiritual issues. These issues are the view of their own morality; sense of time; orientation towards time; values and priorities regarding people and the world around them; and their relationship to the world. Understanding the influence of these concepts on long-term survivors of loss offers professional ways to assist bereaved individuals in developing a healthy identity. Understanding the significance of worldview on survivors' long-term self-perception, values, and priorities may complement existing theories of loss and grieving about how survivors adapt to major life changes and relearn the world. The identity typology can serve as a tool for assessing and guiding bereaved clients towards finding intimacy, meaning, and fulfillment in their post-loss lives. (Contains 26 references.) (JDM)

The process of grief following the suicide of a peer is a difficult problem for adolescents and cannot be equated with how an adult might experience it. The theoretical concern in this paper was that teenagers in Guam might demonstrate a different attitude toward openly communicating their feelings and thoughts about such a sensitive topic as suicide. A workshop was developed to help these adolescents effectively deal with the process of grieving after a classmate's death. The workshop began with 25 questions meant to evoke emotions leading to demonstrations of the students' feelings and a description of the events that brought about those feelings. The one issue that did not arise is that close friends of teenagers who commit suicide are often blamed by the parents of the deceased for some part in their child's suicide. The counselor concluded the workshop by suggesting to the students that positive action be taken to honor the memory of their classmate. An opportunity was given to students to put into writing something affirming about their friend and samples of their writings are included in the appendix. The workshop provided a means of reaching the adolescents that involved cooperation and consultation between a responsible adult and some student leaders. (Contains 4 appendixes and 2 references.) (JDM)

With a sample collected in Barbados, West Indies, study establishes school personnel attitudes toward death and dying and their self-perceived ability to assist grieving students. Findings indicate the need and desire for further preparation for Barbadian school personnel in dealing with bereaved children. (Contains 53 references and 5 tables.) (GCP)

Provides a review of the literature on children's developmental conceptions and reactions to death. Suggestions are made as to provide appropriate intervention strategies that can be used by psychologists, such as individual counseling, play therapy, bibliotherapy, family counseling, and group counseling. (Contains 105 references.) (GCP)