Tim S. Ayers

The family bereavement program: efficacy evaluation of a theory-based prevention program for parentally bereaved children and adolescents.

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.

Coping Efficacy and Psychological Problems of Children of Divorce

Three models of the relations of coping efficacy, coping, and psychological problems of children of divorce were investigated. A structural equation model using cross-sectional data of 356 nine- to twelve-year-old children of divorce yielded results that supported coping efficacy as a mediator of the relations between both active coping and avoiding coping and psychological problems. In a prospective longitudinal model with a subsample of 162 of these children, support was found for Time 2 coping efficacy as a mediator of the relations between Time 1 active coping and Time 2 internalizing of problems. Individual growth curve models over four waves also found support for coping efficacy as a mediator of the relations between active coping and psychological problems. No support was found for alternative models of coping as a mediator of the relations between efficacy and symptoms or for coping efficacy as a moderator of the relations between coping and symptoms.

Developing Linkages between Theory and Intervention in Stress and Coping Processes

The constructs of stress and coping have held an important role in theories about the development of problems of childhood and adolescents and in intervention models about how to prevent the occurrence of such problems (Haggerty, Sherrod, Garmezy, & Rutter, 1994; Rolf, Masten, Cicchetti, Nuechterlein, & Weintraub, 1990; Cowen, 1980; Mrazek & Haggerty, 1994; Hetherington & Blechman, 1996). Stress has been implicated in the development of a wide range of problems, and a rich literature has developed on factors that enable children to be resilient against the negative effects of stress (Gore & Eckenrode, 1994). In a parallel fashion, improving child and adolescent adaptation to stress has been identified as one of the most promising approaches to preventing the development of problems of childhood and adolescence (Compas, Phares, & Ledoux, 1989; Cowen, 1985; Bloom, 1990). For example, in their comprehensive annotated bibliography of primary prevention programs between 1983 and 1991, Trickett, Dahiyal, and Selby (1994) identified 169 citations concerning prevention programs under the headings of stressful life events, social support, and crisis intervention. Many of these stress-based preventive interventions have been empirically evaluated and found to have beneficial effects (Mrazek & Haggerty, 1994; Price, Cowen, Lorion, & Ramos-McKay, 1988). Unfortunately, however, the links between the theoretical and intervention research literatures are not strong.

Resilience in Parentally Bereaved Children and Adolescents Seeking Preventive Services

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 childrens 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 childrens positive adaptation following exposure to adversity.

Evidence-Based Practices for Parentally Bereaved Children and Their Families.

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.

Locus of control and self-esteem as stress-moderators or stress-mediators in parentally bereaved children

Parentally bereaved childrens 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 childrens internalizing and externalizing problems. Implications for understanding parentally bereaved childrens mental health problems and for developing preventive interventions are discussed.

Long-term Effects of the Family Bereavement Program on Multiple Indicators of Grief in Parentally Bereaved Children and Adolescents

OBJECTIVES This article reports on results from a randomized experimental trial of the effects of the Family Bereavement Program (FBP) on multiple measures of grief experienced by parentally bereaved children and adolescents over a 6-year period. METHOD Participants were 244 youths (ages 8-16, mean age = 11.4 years) from 156 families that had experienced the death of a parent. The sample consisted of 53% boys and 47% girls; ethnicity was 67% non-Hispanic White and 33% ethnic minority. Families were randomly assigned to the FBP (N = 135) or a literature control condition (N = 109). Two grief measures, the Texas Revised Inventory of Grief and the Intrusive Grief Thoughts Scale (IGTS) were administered at 4 times over 6 years: pretest, posttest, and 11-month and 6-year follow-ups. A 3rd measure, an adaptation of the Inventory of Traumatic Grief (ITG) was administered only at the 6-year follow-up. RESULTS Compared with the control group, the FBP group showed a greater reduction in their level of problematic grief (IGTS) at posttest and 6-year follow-up and in the percentage at clinical levels of problematic grief at the posttest. The FBP also reduced scores on a dimension of the ITG, Social Detachment/Insecurity, at 6-year follow-up for 3 subgroups: those who experienced lower levels of grief at program entry, older youths, and boys. CONCLUSION These are the first findings from a randomized trial with long-term follow-up of the effects of a program to reduce problematic levels of grief of parentally bereaved youths.

Conceptualization and Measurement of Coping in Children and Adolescents

Recent years have seen a significant increase in the number of efforts to conceptualize and measure coping and to examine the role it plays in effecting the development of symptomatology for people in stressful situations (e.g., Billings & Moos, 1981; Carver, Scheier, & Weintraub, 1989; Endler & Parker, 1990; Folkman & Lazarus, 1980; McCrae, 1984; Miller, 1987; Pearlin & Schooler, 1978). Although the vast majority of these efforts at conceptualization, measurement, and research have involved adult populations, there has been an increase in the number of studies concerning coping by children or adolescents (e.g., Ayers, Sandler, West, & Roosa, 1996; Band & Weisz, 1988; Brodzinsky, Elias, Steiger, & Simon, 1992; Causey & Dubow, 1992; Compas, Malcarne, & Fondacaro, 1988b; Curry & Russ, 1985; Phelps & Jarvis, 1994; Rossman, 1992; Ryan-Wenger, 1990; Wertlieb, Weigel, & Feldstein, 1987; Zeitlin, 1980).

Mediation of the Effects of the Family Bereavement Program on Mental Health Problems of Bereaved Children and Adolescents

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.

Positive Parenting as a Protective Resource for Parentally Bereaved Children

ABSTRACT Positive parenting was examined as a protective resource against the adverse effects of negative life events on parentally bereaved childrens 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 childrens responses to the death of a parent and the development and implementation of preventive interventions are discussed.