Grief and Trauma in Children Grief and Trauma in Children provides easy-to-implement, ready-to-use therapy materials to help busy practitioners use grief and trauma interventions in real-world settings. All interventions in the book have been developed and researched with clinicians who faced challenging environments, includ- ing devastating natural disasters, and in communities where ongoing violence victimized children directly. Even in these stressful environments, clinicians found the interventions easy to implement, effective in helping children acquire coping skills, and effective in decreasing traumatic symptoms in order to proceed with grieving without impaired functioning. Grief and Trauma in Children blends cognitive-behavioral therapy methods and narrative practices to present an integrated grief and trauma model that can be delivered individually, to a group of children, or to a family. The book uses the Draw, Discuss, Write, Witness (DDWW) method to help children explore narratives of resilience and build coping capacity, engage in restorative stories about what happened, and reconnect and re-engage in meaningful ways that allow the child to enjoy life again and get back on track developmentally. Grief and Trauma in Children also provides up-to-date research on childhood bereavement and trauma, a brief description of the theoretical framework of the Grief and Trauma Intervention (GTI) model, a description of session-by-session goals and activi- ties, case examples with ways to address common challenges, and photocopiable tools for clinicians to easily implement the model, such as session agendas, fidelity checklists, handouts for parents, and activity sheets for children. Alison Salloum, PhD, LCSW, is an associate professor in the school of social work at the University of South Florida. This page intentionally left blank Grief and Trauma in Children An Evidence-Based Treatment Manual Alison Salloum First published 2015 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Routledge is an imprint of the Taylor & Francis Group, an informa business © 2015 Alison Salloum The right of Alison Salloum to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. The purchase of this copyright material confers the right on the purchasing institution to photocopy pages which bear the photocopy icon and copyright line at the bottom of the page. No other parts of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Salloum, Alison, 1966- Grief and trauma in children : an evidence-based treatment manual / by Alison Salloum. pages cm Includes bibliographical references and index. 1. Psychic trauma in children—Treatment. 2. Grief in children. 3. Grief therapy. 4. Child psychotherapy. I. Title. RJ506.P66S25 2015 618.92´8521—dc23 2014033306 ISBN: 978-0-415-70828-9 (hbk) ISBN: 978-0-415-70829-6 (pbk) ISBN: 978-1-315-88613-8 (ebk) Typeset in Perpetua and Bell Gothic by Keystroke, Station Road, Codsall, Wolverhampton Contents Overview vii Acknowledgments ix 1 Introduction 1 Current Research on Childhood Bereavement and Trauma 1 Development of an Evidence-Based Grief and Trauma Intervention (GTI) for Children 5 Framework for an Empirically-Informed Grief and Trauma Intervention for Children 10 Steps for Narrative Activities – DDWW: Draw, Discuss, Write, Witness 12 Goals and Outline of GTI for Children 14 2 Getting Ready to Implement GTI for Children 17 Environmental Support 17 How to Use This Manual 19 Tips for Facilitating the Sessions 19 Criteria for Participation 20 Abuse, Neglect, and Domestic Violence 21 Critical Logistics 22 3 Practitioner Support 26 Worker Stress and Self-Care 26 Trauma-Informed Care 28 Pre and Post Clinician Meetings 31 4 Screening and Evaluating 36 Assessment Tools and Evaluation 36 Evaluator 38 First Meeting with Child: Individual Screening with Child 39 Group Composition and Co-Leaders 47 Use of the Clinical Chart 47 v CONTENTS 5 Parents and Other Important Adults 50 Parents/Caregivers 50 Parent/Caregiver Meeting Agenda 51 Teachers and Staff Education and “Check-Ins” 59 6 GTI for Children Sessions 63 Procedures for Missed Sessions 63 Number of Sessions 64 Session 1 65 Session 2 69 Session 3 73 Session 4 76 Session 5 78 Session 6 80 Additional Individual “Pull-Out” 84 Session 7 86 Session 8 88 Session 9 90 Session 10 92 Ending GTI for Children 93 7 GTI for Children in Action 95 Common Questions, Responses, and Vignettes 95 8 In-Session Guidance 106 Session Agendas 106 9 Treatment Adherence 120 Adherence to GTI for Children 120 Adherence Checklist 122 Appendix: GTI for Children Activity Sheets 130 Index 175 vi Overview Grief and Trauma in Children: An Evidence-Based Treatment Manual focuses on how to help children who are experiencing grief and trauma. This manual describes an evidence-based grief and trauma intervention called Grief and Trauma Intervention (GTI) for Children. While informa- tion on research and theory is included, the emphasis is on providing an easy-to-implement, ready-to-use therapy manual to help busy practitioners use GTI for Children in real-world set- tings. GTI for Children was developed and underwent research with clinicians who were faced with implementing GTI for Children in challenging environments such as in the aftermath of devastating disasters or in communities where ongoing violence surrounded children who were participating in GTI for Children. Even in these stressful environments, clinicians found GTI for Children easy to implement and effective in helping children acquire coping skills, and in decreasing traumatic symptoms in order to proceed with grieving without impaired functioning. This manual incorporates all of the lessons learned regarding how best to simplify imple- mentation and incorporate techniques that work in the real world. GTI for Children, a brief intervention, blends cognitive-behavioral therapy methods and narrative practices to help chil- dren who are experiencing both grief and trauma. GTI for Children is an integrated grief and trauma model that can be delivered individually, to a group of children, or to a family. It uses the Draw, Discuss, Write, Witness (DDWW) method to help children explore narratives of resilience and build coping capacity, engage in restorative stories about what happened, and reconnect and re-engage in meaningful ways that allow the child to enjoy life again and get back on track developmentally. vii This page intentionally left blank Acknowledgments This manual is the result of working with many excellent clinicians and researchers. The Children’s Bureau of New Orleans, Inc. Project LAST, Loss and Survival Team, over the years has constantly strived to provide accessible, affordable, and effective services to children experi- encing grief and posttraumatic stress. I wish to express my sincere appreciation to the Project LAST team members and to the children who bravely participated in the Grief and Trauma Interventions. Thank you also to Dr. Stacy Overstreet, Tulane University, Department of Psychology, who joined me after Hurricane Katrina to continue to evaluate GTI for Children; and current and former Presidents/CEOs of Children’s Bureau of New Orleans, Inc.: Paulette Carter, LCSW, MPH; Nina Kelly, Ph.D.; Ronald P. McClain, LCSW, J.D. This manual is based on three evaluative projects, and the people who assisted with these studies are listed below: Evaluation Team: Alison Salloum Tye Kelley Stacy Overstreet Sarah Larke Abbe N. Garfinkel (Project Coordinator 2008–2010) Jessica Messia de Prado Laura Garside (Project Coordinator 2006) Kathryn Moore Lou Irwin (Clinical Consultant) Lauren Sampson Adrian Anderson Carl Segura Wendy Baum Carlolice Shepherd JoAnn Bruster Angelique Trask-Tate Berre Burch Sarah Van Thompson Clarissa Colley Mullady Voelker Daisy Cummings Stacy Washington Lauren Eckstien Jill West Anita Francois (Project Director) Mia White Sharon Gancarz-Davies Carrie Wilson Lauren Hensley ix