“I’m Not Alone”: A Group Intervention for Grieving Children

Participants

At intake, demographic data were collected from all students who participated in groups conducted in academic years 2018 to 2019 and 2019 to 2020 in the mid-Atlantic region of the United States (N = 434; elementary school = 210; middle school = 171; high school = 48; missing = 5). Three students participated in the groups more than once. Most of the students who attended the groups identified as girls (57.4%, 41% as boys, and 1.6% chose not to indicate gender). The students represented diverse racial groups (28.8% Latina/o/x, 28.6% White, 28.1% Black, 6.7% Multiracial, 4.4% Asian, and 3.4% Other). The majority were grieving a recent loss (34.8% within 6 months, 17.1% from 7 months to 1 year, 17.3% between 1 and 2 years, and 28.1% beyond 2 years; 2.8% missing data). Students were mostly grieving the deaths of family members, including grandparents (30%), fathers (27%), mothers (14.5%), and siblings (7.6%), among others. Many students (28.6%) experienced traumatic deaths from suicide, homicide, accidents, or military service; the majority of individuals died from an illness (55.5%).

During the last group session, participants were invited to complete evaluations; 318 students provided feedback about the groups (163 elementary school and 155 middle and high school students; a 73% return rate). In addition, 59 group facilitators (all White females) and 59 school counselors (demographic information not collected) indicated the degree to which students learned and changed through their participation in the Good Grief Club.

Procedure

Over 25 years ago, a community organization developed a partnership with a large and diverse school district (current enrollment = 163,000 students) to provide grief groups in schools during the school day. Annually, a memorandum of understanding is signed that outlines the roles of the community organization, volunteer group facilitators, schools, and school counselors. The groups are facilitated by the trained community volunteers in the presence of school counselors, thus reducing the burden on school personnel to create, prepare, facilitate, or evaluate the groups. The school counselors identify students, obtain parental/guardian consent, reserve a private room for the groups, and choose their degree of participation in the sessions from being present to participating actively as co-leaders.

The community organization created three separate curricula (elementary, middle, and high school) for the grief groups based on the literature and in consultation with school counselors and a psychologist. Each session comprised experiential activities, expressive arts, and guided conversations tailored for the age and developmental level of the students. The groups ran weekly for seven 1-hr sessions during which students learned about grief, interacted with other students who experienced a loss, shared their stories and feelings related to the death, identified ways to obtain social support, recognized their strengths and healthy ways to cope, and brainstormed how to maintain continuing bonds with their loved one (see Table 1). The groups were free to the children due to philanthropic support raised by the community organization from family foundations, individual donors, and local government contracts.

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Table 1.

Good Grief Club: Topics, Objectives, and Activities.

Session	Topics	Objectives	Activities
1	Introductions and creating safe space	Getting acquainted; sharing loss	Ice breakers; draw or tell story of who died, how, and when they died
2	Changes inside me	Defining grief and the feelings that come when someone I love dies	Feelings ball; feelings bingo; grief jacket
3	Changes inside me	More feelings that come with grief; grief comes in waves	Wave bottle; feelings bauble
4	Changes around me	Adjusting to change; what can I control; who's on my team?	Identify what students can control; name people who can help; block activity
5	Tools to cope and build resilience	Tools I can use; strengths I can call on to help cope with my grief	My tree of strength; healthy/harmful choices; identify self-soothing activities
6	Tools to cope and build resilience	Remembering how far I’ve come and the person who died	Share photographs of loved ones; create memory box; frame decoration
7	Enduring bonds and continuing relationships	Wrapping up; unanswered questions	Review of sessions; unanswered questions discussion; complete evaluation; celebrate loved one and the Good Grief Club journey
Floating sessions	Special days	Acknowledge special days are hard; learn ways to cope	Identify ways to remember deceased; make a plan to celebrate (or not)

The community organization recruited and trained community volunteers to lead the grief groups. Adult volunteers have been shown to be effective in providing interventions in school settings (e.g., reading programs for struggling readers, Villiger et al., 2019; tutoring for elementary and middle school students, Ritter et al., 2009; and volunteer-facilitated peer support groups, Wassef et al., 1998). The Good Grief Club volunteers participated in a three-day training that provided a comprehensive overview of loss, grief, end-of-life experiences, and hospice care. Volunteers then completed an additional 2-day training on leading grief groups. After completion of both trainings, volunteers were approved to become group facilitators and received a manual outlining the group sessions along with materials for the group activities. Organization staff maintained close contact and provided ongoing support to the facilitators.

Grief groups were scheduled when school counselors contacted the community organization or when community organization staff contacted schools and learned of the need for grief groups. A minimum of four students were required for each group. Students were referred to the groups by teachers, counselors, or parents/guardians. If the school counselor determined that the child was ready and appropriate for the grief group based on individual meetings with the student, written permission from parents/guardians was sought by the counselor. After receipt of permission, an individual intake session was scheduled with the student and the group facilitator to further assess student readiness and suitability for the group and, when appropriate, to invite the student to participate in the grief group. Students who agreed to participate began the seven-session grief intervention. Attendance in the grief groups was approximately 86%.

Based on research, the stated goals/content of the group interventions and the reading level of the students, staff at the community agency developed and revised the assessments over time. They also collected and entered the evaluation data from students, group facilitators, and school counselors. University researchers were then invited to join the community partnership to assist with a preliminary evaluation of the effectiveness of the grief groups. After receipt of Institutional Review Board approval, non-identifiable data were shared with the university researchers.

Measures

Data Analyses

With regard to the quantitative data, means and standard deviations were calculated for the items of interest in this study. Directed content analysis was used to identify common themes in responses to the open-ended questions (Roberts, 2001). In this structured form of content analysis, existing research was used to inform initial coding themes or categories for the data (Hsieh & Shannon, 2005). First, guided by prior research and knowledge about the group intervention, possible themes were generated by a research team consisting of one professor, four graduate students (all of whom had conducted grief-related research), and four undergraduate students who were majoring in psychology. Next, teams of two reviewed responses to each question and created additional themes.

After training, two team members independently coded the responses for each question into themes. When there was disagreement about the themes, the team members met to discuss the discrepancies and to achieve consensus. On a small number of responses, the coders were unable to agree and a graduate student or professor contributed a code for the response.

Limitations

With regard to this study (and reflective of many community intervention evaluations), the greatest limitations were the lack of pre-test data and control groups, which did not allow the assessment of the degree to which the desired outcomes changed over time and as a result of the intervention. In addition, the measures were created by the community organization and did not have established psychometric properties. The question on coping strategies assessed what students planned to do when struggling with their grief, as opposed to what they actually did during challenging times. Furthermore, young children may not answer survey questions in a reliable manner. The group facilitators and school counselors may have been biased toward seeing positive outcomes because of their investment in the grief groups and because of the way in which the questions were worded. Additionally, all of the facilitators were White and demographic information was not collected for the school counselors. Family members were not involved in the intervention; although, their involvement could have extended the benefits of the grief groups for the children by ensuring that family members also had knowledge about grief and healthy coping strategies. Moreover, family members could have provided helpful observations regarding changes in the students as a result of participation in Good Grief Clubs. Finally, the research did not assess whether the effects of the group lasted over time.

Future Research Implications

Future researchers should administer pre- and post-test surveys and conduct randomized clinical trials with control groups to assess the effectiveness of the group intervention. The university researchers might be involved at the start of the project to share knowledge of psychometrically sound measures and access to research databases. In addition, measures with established psychometric properties should be used. Ideally, multiple forms of assessment would include parent/guardian and teacher ratings of change over time. Longitudinal investigations are needed to determine if early intervention prevents long-term negative outcomes, particularly mental health consequences. Students could be surveyed several months after the conclusion of the group to determine if they retained knowledge about grief, used the coping strategies that they learned, and had any suggestions for improvements to the intervention. Furthermore, consistent with the findings of Currier et al. (2007), future research should examine whether group interventions might be most effective for children when delivered close to the time of the death and if the child demonstrates a clear need for treatment. An evaluation of posttraumatic growth after group participation would also be of considerable interest.

In addition, the findings of this and future investigations should be shared beyond academic conferences and journals. In particular, school boards, counselors, teachers, and administrators, as well as PTA/PTSA members and parents/guardians, would benefit from learning about the effectiveness of grief groups for bereaved children.

Future Counseling Implications

School-based grief interventions for diverse students are desperately needed given the devastating numbers of COVID-19–bereaved children, especially children of color (Treglia et al., 2021). Given the promising nature of the intervention, a manual describing the group activities could be standardized and disseminated widely. In communities that may not have the resources to train volunteers to facilitate grief groups in their schools, school counselors can be taught to implement the components of the groups that appeared most helpful (i.e., providing grieving students with a place to share feelings, perhaps through after-school clubs). Knowledge about grieving could be shared in health classes at all grade levels, and students could be educated about how to respond to grieving peers to reduce isolation (Hill & O’Brien, 2021). Grieving students could be taught about common strategies to cope with death using an acronym (REST) based on our findings: remember them, engage in activities, seek support, and take care of you. Moreover, the grief groups could inform the development of community interventions for grieving families to provide family members with a space to share feelings, reduce isolation, and learn coping skills.

Furthermore, as there was considerable diversity among the students who participated in the grief groups and given that culture profoundly affects responses to death and grieving practices (Rosenblatt, 2008), opportunities for children to share their cultural traditions could be integrated into each group session. For example, group participants could be invited to share cultural traditions related to remembering the deceased or bring foods representing their cultures to the final celebratory session of the Good Grief Club. In addition, the recruitment of diverse group facilitators and school counselors to lead Good Grief Clubs could enhance the experiences of the diverse students in the intervention.

Future Implications for Community Partnerships

Working with community agencies to conduct program evaluations provides the opportunity to be involved in meaningful research with significant real-world implications for preventing problems and facilitating positive outcomes. Goodman and colleagues (2004) cautioned against “drive by data collection” in which researchers obtain data from communities with no involvement in their work or no reciprocity with regard to learning and sharing the results of the research. Recently, Barrio Minton et al., 2021 provided a guide for engaging in collaborative partnerships to conduct program evaluations that ensure that the voices of community members are represented. Partnerships with community organizations can advance social justice and ideally enable scholars to both learn from community members and use their knowledge to improve the lives of others (APA, 2017).