Grief and Trauma Intervention (GTI) for Children

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Grief and Trauma Intervention (GTI) for Children has been rated by the CEBC in the area of: Trauma Treatment - Client-Level Interventions (Child & Adolescent).

Target Population: Children who are experiencing grief and posttraumatic stress

For children/adolescents ages: 7 – 12

For parents/caregivers of children ages: 7 – 12

Brief Description

GTI is designed for children ages 7 to 12 with posttraumatic stress due to witnessing or being a direct victim of one or more types of violence or a disaster, or due to experiencing or witnessing the death of a loved one, including death by homicide. The purpose of the intervention is to improve symptoms of posttraumatic stress, depression, and traumatic grief. The intervention is conducted with children in a group or individual format in 10 sessions of approximately 1 hour with at least one session with the parent. The techniques used in the sessions are grounded in cognitive-behavioral therapy (CBT) and narrative therapy and include narrative exposure to the trauma (through drawing, discussing, and writing), development of an in-depth, coherent narrative while eliciting the child's thoughts and feelings, development of positive coping strategies, and making meaning of losses.

Program Goals:

The goals of Grief and Trauma Intervention (GTI) for Children are:

  • Learn more about grief and traumatic reactions
  • Express thoughts and feelings about what happened
  • Decrease posttraumatic stress reactions
  • Build coping capacity

Essential Components

The essential components of the Grief and Trauma Intervention (GTI) for Children include:

  • Individual or group format
  • Parent meetings
  • Integrate cognitive-behavioral methods and narrative practice skills to address traumatic stress and grief and loss
  • Three Phases:
    • Resilience: Promote resilience
    • Restorative Retelling: Guide the children through restorative retelling
    • Reconnecting: Build connections
  • Ground the interventions in the DEC:
    • Developmentally appropriate
    • Ecological perspective
    • Culturally relevant

Child/Adolescent Services

Grief and Trauma Intervention (GTI) for Children directly provides services to children/adolescents and addresses the following:

  • Posttraumatic stress, depression, and internalizing and externalizing symptoms

Parent/Caregiver Services

Grief and Trauma Intervention (GTI) for Children directly provides services to parents/caregivers and addresses the following:

  • Parent of a child who is experiencing posttraumatic stress and grief
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: There is at least one parent-child meeting although additional family sessions (including other family members or just with the parent) can be added as needed.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Outpatient Clinic
  • Residential Care Facility
  • School

Homework

This program does not include a homework component.

Languages

Grief and Trauma Intervention (GTI) for Children does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

Copies of worksheets, art supplies, and private space/room

Minimum Provider Qualifications

Master’s degree in mental health related field

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training may be provided on-site and it is also offered annually at the Children’s Bureau of New Orleans.

Number of days/hours:

Two-day training and consultation through at least one cycle of implementation of GTI for Children

Additional Resources:

There currently are additional qualified resources for training:

Training is also offered by the Children’s Bureau of New Orleans, Contact pcarter@childrensbureaunola.org.

Implementation Information

Since Grief and Trauma Intervention (GTI) for Children is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Grief and Trauma Intervention (GTI) for Children.

Formal Support for Implementation

There is formal support available for implementation of Grief and Trauma Intervention (GTI) for Children as listed below:

Consultation throughout the implementation of GTI for Children may be provided as part of the training package.

Fidelity Measures

There are fidelity measures for Grief and Trauma Intervention (GTI) for Children as listed below:

In the treatment manual, the there is a chapter on adherence to GTI and a fidelity checklist is provided. See Salloum, A. (2015). Grief and trauma in children: An evidence-based treatment manual. New York, NY: Routledge.

Implementation Guides or Manuals

There are implementation guides or manuals for Grief and Trauma Intervention (GTI) for Children as listed below:

The intervention manual, Grief and trauma in children: An evidence-based treatment manual, has been published and is available for purchase on-line at https://www.routledge.com/products/9780415708296

Research on How to Implement the Program

Research has been conducted on how to implement Grief and Trauma Intervention (GTI) for Children as listed below:

Salloum, A., & Smyth, K. (2013). Clinicians’ experiences of a podcast series on implementing a manualized treatment. Journal of Technology in Human Services, 31(1), 71-83. doi:10.1080/15228835.2012.738382

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Salloum, A., Avery, L., & McClain, R. P. (2001). Group psychotherapy for adolescent survivors of homicide victims: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1261-1267.

Type of Study: One-group pretest–posttest study
Number of Participants: 45

Population:

  • Age — Children: 11-19 years, Parents: Not specified
  • Race/Ethnicity — Children: 100% African American; Parents: Not specified
  • Gender — Children: 52% Female, 48% Male; Parents: Not specified
  • Status — Participants included low-income urban African American child survivors of homicide victims and/or children who have been exposed to violence

Location/Institution: Children’s Bureau of New Orleans, Louisiana

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of a time-limited psychotherapy group model Project Last [now called Grief and Trauma Intervention (GTI) for Children] to decrease traumatic symptoms among adolescent survivors of homicide victims. Measure utilized was the Child Posttraumatic Stress Reaction Index (CPTS-RI). Results indicate group therapy may be helpful in reducing PTSD symptoms among adolescent survivors of homicide victims. Total Child PTSD Reaction Index scores, as well as scores on two of three symptom clusters, were significantly reduced at the posttest. Limitations include lack of control or comparison group, lack of randomization of participants, and lack of follow-up.

Length of postintervention follow-up: None.

Salloum, A. (2008). Group therapy for children experiencing grief and trauma due to homicide and violence: A pilot study. Research on Social Work Practice, 18(3), 198-211.

Type of Study: One-group pretest–posttest study (Secondary data analysis)
Number of Participants: 117

Population:

  • Age — Children: 6-12 years, Parents: Not specified
  • Race/Ethnicity — Children: 100% African American, Parents: Not specified
  • Gender — Children: 52% Female and 48% Male, Parents: Not specified
  • Status — Participants included low-income urban African American child survivors of homicide victims and/or children who have been exposed to violence

Location/Institution: Children’s Bureau of New Orleans, Louisiana

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes information from a previous study Salloum et al. (2001). This study involved a secondary analysis using data from child group participants’ case records from Children’s Bureau of New Orleans to examine children who participated in the Project LAST [now called Grief and Trauma Intervention (GTI) for Children] elementary-age grief and trauma intervention. Measure utilized was the Child Posttraumatic Stress Reaction Index (CPTS-RI). Results indicate that low-income African American urban children who participated in the school-based grief- and trauma-focused intervention experienced fewer symptoms of posttraumatic stress at the end of intervention primarily in the areas of avoidance and re-experiencing symptoms. Limitations include lack of control or comparison group, lack of randomization of participants, and lack of follow-up.

Length of postintervention follow-up: None.

Salloum, A., & Overstreet, S. (2008). Evaluation of individual and group grief and trauma interventions for children post disaster. Journal of Clinical Child and Adolescent Psychology, 37(3), 495- 507.

Type of Study: Randomized controlled trial
Number of Participants: 56

Population:

  • Age — Children: 7-12 years, Parents: Not specified
  • Race/Ethnicity — Children: 51% African American, 2% Caucasian, 2% Hispanic, 2% African American/Native American; Parents: Not specified
  • Gender — Children: 64% Male and 36% Female, Parents: Not specified
  • Status — Participants who experienced different types of potentially traumatic events

Location/Institution: Children’s Bureau of New Orleans, Louisiana

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated a community-based grief and trauma intervention for children, Project Last [now called Grief and Trauma Intervention (GTI) for Children] conducted postdisaster. Children were randomly assigned to two groups: individual treatment and group treatment. Measures utilized include the UCLA Posttraumatic Stress Disorder Index for DSM–IV (UCLA–PTSD-Index), the Mood and Feelings Questionnaire–Child Version (MFQ–C), and the UCLA Grief Inventory–Revised. Results indicate that there was a significant decrease in all outcome measures over time, and there were no differences in outcomes between children who participated in group intervention and those who participated in individual intervention. Limitations include lack of a control group, small sample size, and length of follow-up.

Length of postintervention follow-up: 1-31 days (Mean=20 days).

Salloum, A., & Overstreet, S. (2012). Grief and trauma intervention for children after disaster: Exploring coping skills versus trauma narration. Behaviour Research and Therapy, 50(3), 169-179. doi:10.1016/j.brat.2012.01.001

Type of Study: Randomized controlled trial
Number of Participants: 70

Population:

  • Age — Children: 6-12 years, Parents: Not specified
  • Race/Ethnicity — Children:100% African American; Parents: Not specified
  • Gender — Children: 39 Male and 31Female, Parents: Not specified
  • Status — Participants who experienced different types of potentially traumatic events in Hurricanes Katrina and Gustav.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) [now called Grief and Trauma Invention (GTI) for Children] and coping skills only (C). Participants were randomly assigned to two groups: 1) GTI with coping skills and narrative construction (GTI-CN) and 2) GTI with coping skills (GTI-C) Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures include the Mood and Feelings Questionnaire-Child Version (MFQ-C), the UCLA Posttraumatic Stress Disorder Index for DSM-IV (UCLA-PTSD Index), the Extended Grief Inventory, Multidimensional Scale of Perceived Social Support (MSPSS), the Child behavior checklist (CBCL), and the Things I Have Seen and Heard survey. Results indicate that children assigned to GTI-CN reported expressing their thoughts and feelings more than the GTI-C group, who tended to report learning more ways to cope than children in the GTI-CN group. Additionally, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months postintervention. Limitations include lack of control group, small sample size, and reliability on self-reported measures.

Length of postintervention follow-up: 3 months and 12 months.

References

Salloum, A. (2015). Grief and trauma in children: An evidence-based treatment manual. New York, NY: Routledge.

Salloum, A., Garfield, L., Irwin, A., Anderson, A., & Francois, A. (2009). Grief and trauma group therapy with children after Hurricane Katrina. Social Work with Groups, 32(1-2), 67-79. doi:10.1080/01609510802290958

Salloum, A., & Rynearson, E. K. (2006). Family resilience after violent death. In E. K. Rynearson (Ed.), Violent death: Resilience and intervention beyond the crisis (pp.47-64). Oxford, UK: Routledge Publishing.

Contact Information

Name: Alison Salloum, PhD
Email:
Phone: (813) 974-1535
Fax: (813) 974-4675

Date Research Evidence Last Reviewed by CEBC: March 2016

Date Program Content Last Reviewed by Program Staff: July 2016

Date Program Originally Loaded onto CEBC: July 2016