The challenge of evaluating a child bereavement programme

Evaluation of the CHUMS Child Bereavement Group: A Pilot Study Examining Statistical and Clinical Change

This article describes the largest evaluation of a UK child bereavement service to date. Change was assessed using conventional statistical tests as well as clinical significance methodology. Consistent with the fact that the intervention was offered on a universal, preventative basis, bereaved young people experienced a statistically significant, small to medium-sized decrease in symptoms over time. This change was equivalent across child age and gender. Type of bereavement had a slight impact on change when rated by parents. Potential clinical implications are highlighted, and various limitations are discussed that we hope to address using an experimental design in future research.

Are children's grief camps effective?

Bereavement camps are one form of popular grief intervention for children. A review of the existing literature on child bereavement camps was conducted to examine effectiveness of these camps. An initial database search led to 187 entries. Selection criteria employed resulted in a total of eight studies for an in-depth examination. While camps had differences in their lengths, camper acceptance, restrictions, and theoretical frameworks used; many shared similar camp goals and objectives, activities, and outcome measures. Emerging evidence shows camps are promising venues to help bereaved children develop and build resilience in dealing with loss.

Peer-group support for bereaved children: a qualitative interview study

BACKGROUND

  While it has been shown that bereaved children can experience emotional or behavioural problems, the evidence is inconclusive regarding which children would benefit from support and the kind of support to offer. This study aimed to obtain children's and parents' views on their experiences following bereavement and the usefulness of a peer-group support programme.

METHOD

  Thirty-nine families who had attended a community-based peer-group bereavement support programme within the previous 4 years were approached. Of the 23 with confirmed contact details, 17 agreed to participate. Qualitative interviews were conducted with 23 children (range 8 to 17 years) and 17 parents.

RESULTS

  Children were concerned about isolation from peers and emphasized the value of meeting other children with experiences of bereavement in the group. Parents were concerned about lack of communication within the home about the bereavement, which continued after the group. Most children and parents would have liked more support, either more groups or an ongoing link.

CONCLUSIONS

  Referral to peer-group support may have the potential to improve bereaved children experiencing feelings of social isolation and help them develop coping strategies. Other family-focused support may also be needed for some children.

Young people living with parental bereavement: Insights from an ethnographic study of a UK childhood bereavement service

The purpose of this two-year ethnographic study was to explore the experiences of parentally bereaved young people who sought support from the Rocky Centre (a pseudonym), a childhood bereavement service in the United Kingdom. Data were generated from extended periods of participant observation and semi-structured interviews with both staff and service users. In this article we focus specifically on the interviews with 13 young people to elucidate the factors that helped them to live with parental bereavement. Of these participants, four had been recently bereaved and nine had experienced the death of a parent over ten years ago. Seven key themes emerged from the analysis of the interview data: expressing emotion, physical activity, positive adult relationship(s), area of competence, friendships/social support, having fun/humour and transcendence. These themes are discussed in turn, and implications for research and practice are addressed.

Evaluation of a British child bereavement service: The user's perspective

Objective:

This article summarizes the findings from a 3-year independent evaluation of a regional Child Bereavement Service (CBS). The service was commissioned by a Primary Care Trust in Northern England, and funded by a British cancer charity, Macmillan Cancer Support. The need for a CBS was recognized by members of a Palliative Care Group who identified a gap in local services for bereaved children, who may be susceptible to short/long-term psychiatric/psychological disorders. The service was established to offer support for professionals working with bereaved children and their family.

Method:

Interventions provided by the service included pre/post bereavement support, individual work with the child and/or family, and group work. An evaluation (2004–2007), was conducted to inform service development utilizing semi-structured interviews with parents/carers of service users (n = 20), and semi-structured interviews with healthcare professionals (n = 8). Interviews were recorded, transcribed verbatim, and analyzed using grounded theory methods.

Results:

Referrals were higher than expected. Sixty per year were anticipated; however, in the first year alone, there were 255 referrals. Health and social care professionals who attended training courses, provided by the CBS staff, expressed confidence in providing bereavement support themselves, or by making appropriate referrals to the CBS. Parents and carers welcomed a service specifically for their children.

Significance of results:

The CBS is a viable organization that supports bereaved children as expressed in this article.

Childhood abuse uncovered in a palliative care audit

Objective:

This article aims to highlight potentially high levels of childhood sexual abuse within Cancer and Palliative Care Service users.

Methods:

During a routine audit, data was collated to quantify a perceived high level of disclosure of pre-existing psychological trauma within the palliative care caseload of a Macmillan Children and Families Therapist. Families comprised adults (generally parents or step-parents), one of whom was terminally ill or recently deceased who had direct responsibility for children and young people aged under 20 years old. Each family had at least two members using the service for advice, emotional support or counselling.

Results:

A childhood sexual abuse rate of 33% for women and 10% for men was revealed. Of 59 families, 49% had one or more members who had experienced childhood sexual abuse. In addition a further 9% of adults had experienced severe physical and emotional abuse in childhood. Many families had faced multiple trauma.

Significance of results:

Palliative care clinicians have access to detailed personal and family history during a highly vulnerable transition. While confidentiality is paramount it is essential to develop better data collection methods and raise the profile of childhood sexual abuse as a major contributing factor to morbidity. A whole family assessment is crucial to ensure child protection and emotional care for children facing the loss and subsequently bereaved of a parent or a carer. Clinicians must be able to offer a range of approaches which provide distressed patients with a history of childhood abuse some sense of emotional containment at the end of life, a challenge which cannot be overstated.

Bereaved parents' experiences of the use of 'cold bedrooms' following the death of their child

INTRODUCTION

Children's hospices have the facilities to enable a child to remain at the hospice following their death until the time of the funeral if desired by the family. The use of cold bedrooms (or beds) to reduce the rate of the body's physical deterioration enables the family to have unrestricted access and close proximity to the child throughout the 24-hour period.

AIM

To explore how bereaved families experience the child remaining in a cold bedroom following the child's death in the period January 2002-March 2005.

OBJECTIVE

To survey all the families whose child had been cared for in a cold bedroom in one children's hospice in South-East England (n=34).

METHOD

A retrospective cross-sectional survey using a postal questionnaire was conducted. Questionnaires were sent to the 31 bereaved families who were considered eligible for participation.

RESPONSE

Sixteen completed questionnaires were returned (51.6%); four families declined participation (12.9%); eleven families did not reply (35.5%).

RESULTS

The experiences of sixteen families were obtained. The families expressed that they found the experience physically, practically and emotionally supportive, as they were able to continue to act as the child's parents, to choose and control how their child's care occurred, to say their farewells at their own pace and to plan the funeral of their choice. These results must be interpreted with the clear recognition that the experiences of 48.4% of the sample are unknown. Reasons for non-participation were explored.

CONCLUSION

The study has methodological limitations but presents an investigation into the experiences of parents whose child has been cared for in a cold bedroom. These families all described the experience positively.

Are we getting it right? Parents' perceptions of hospice child bereavement support services

OBJECTIVE

To determine parents' experiences and perceptions of a support service for families with bereaved children, provided by a UK charity for cancer patients in seven hospices in the UK.

METHOD

Individual interviews with 25 purposively selected parents.

RESULTS

Parents used the service for: advice and reassurance; support for their children while they grieved; and advice on ameliorating behavioural difficulties at home and school. Non-service users did not think formalised support was necessary or had other sufficient support. Nevertheless, important to parents in both groups was that the service existed so their children's needs were being or could be addressed. Children and their parents benefited from talking to a non-family member, and being involved in social events that reduced feelings of isolation.

CONCLUSION

The hospice child bereavement service was offered as an integral part of palliative cancer care support. Future research could explore collaborative work between counsellors and other professionals.

Annotation: randomised trials

BACKGROUND

This annotation describes the uses of randomised controlled trials (RCTs) in clinical child psychology and psychiatry.

METHOD

It explores the scientific basis for randomised designs, the conceptual and methodological issues that can arise when using them, alternative methods, and future directions.

RESULTS

There are many issues that have to be tackled when using randomised trials to answer questions about the effectiveness of interventions used by child mental health professionals. The most important are conceptual issues concerning the design of these studies, practical issues, and issues about the interpretation of the results. There are some situations in which randomised trials are not possible or ideal and alternative strategies may therefore be needed. Future RCTs should be more explicit about whether their primary purpose is to further scientific knowledge or to evaluate the benefit of a treatment in routine clinical practice. Future trials should also have outcomes of unequivocal significance and be reported in accordance with standardised guidelines.

CONCLUSIONS

Well-designed and unambiguously reported RCTs usually provide the best possible evidence about the effectiveness of an intervention. RCTs are not, however, the only way of establishing cause and effect and their results should always be interpreted in the light of other evidence.

Do community-based support services benefit bereaved children? A review of empirical evidence

AIMS

To consider the evidence of effect from English language, empirically based quantitative evaluations of community-based interventions for bereaved children; community-based interventions being understood as those taking place outside a clinical setting.

METHODS

MedLine, PsychInfo, Applied Social Sciences Index and Sociological Abstracts were searched for documents containing the words 'child', 'bereavement' and 'program', 'group', 'intervention', 'support' or 'evaluation'. The criterion for inclusion was that studies use a control group or pre- and post-test measurements using a standardized instrument.

RESULTS

Nine relevant studies were identified. However, empirical evidence of positive outcomes for children was limited and compromised by methodological weaknesses in the design of the studies. Small sample sizes, irregular attendance, high levels of attrition, short time scales between pre- and post-testing and difficulty in developing appropriate instrumentation, including assessment of adherence to the agreed intervention programme, all created problems.

CONCLUSIONS

The case for universal inclusion of this group of children in such support programmes remains unproven, and further exploration of the outcomes of a range of different community interventions is required, with a specific focus on long-term and/or unwanted effects and evaluation of the basis for referral.

A weekend camp for bereaved siblings

PURPOSE

The purpose of this article is to describe a weekend bereavement camp for children age 6 to 18 years who have lost a brother or sister to cancer. A description of the planning for the camp and the weekend program is included.

OVERVIEW

Camp New Horizons is a weekend camp for children age 6 to 18 years who have lost a sibling to cancer. At the camp, the children are divided into age-appropriate groups and spend time, through various activities, learning about the grief process to reduce their feelings of isolation, to express grief appropriately, and to move forward in the grief process. Similar programs, as well as the uniqueness of this program, are discussed.

CLINICAL IMPLICATIONS

Camp New Horizons has met many of the educational and support needs of bereaved siblings. Networks of support and friendship have formed that allow the children to reach out to one another when needed. Parents and children have increased their communication about the death in their family, thus accepting their feelings and increasing support in the family system. Continued collaboration between centers will create ongoing support for the healthcare professionals and the programs they provide.

Coping with loss: the development and evaluation of a children's bereavement project

The 'Kingfisher Project' is a community-based programme of support groups for bereaved children. It has been developed by a multi-disciplinary group of workers from health, education, social services and the voluntary sector. Thirty-six children and young people have have been through the first five groups of the programme. Children accessing the service are predominantly those at high risk of developing longer-term problems as a result of bereavement. Evaluation indicates that the children and young people benefit in terms of increased social, behavioural, emotional and physical well-being. Two sub-groups appear to have benefited less: these are children and young people with learning difficulties, and teenage girls. Project evaluation has enabled workers to develop insights into the programme's strengths and weaknesses and has raised questions which merit further exploration.