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5/9/2018 Enhancing TF-CBT for Grieving Youth and Families Dee Bigfoot Roy Van Tassell The Many Dimensions of Grief / Loss Causes 1 5/9/2018 The Many Dimensions of Grief / Loss Expressions / responses Traumatic Grief: When Trauma and loss Intertwine Situation where a child or adult has lost someone they cared about to a death/loss that is perceived as traumatic such as: homicide, fatal car accident, illness, suicide, separation, terminated rights, etc. AND The trauma symptoms experienced interfere with the ability to move thru the normal grieving process. 2 5/9/2018 Traumatic Separation in Children • Loss of a parent / caregiver (or close family member) for varying or indefinite time, numerous reasons • Illness, incarceration, immigration, abduction, deportation, deployment, removal or termination of rights, other • May develop PTS symptoms and be similar in reaction to CTG • Impact by trauma that caused removal, trauma as part of removal(s), hope for or even fear of reunification • Broad reactions: anger at others, self blame, blame of parent, feeling abandoned, minimizing parent responsibility, emotional numbing or distancing, hopeless, emptiness, loss of meaning • https://www.nctsn.org/what-is-child-trauma/trauma-types/traumatic- grief Current Understanding of TG • DSM-5 doesn’t recognize a mental health diagnosis for traumatic grief adults or kids. • The field has recognize the condition through practice and clinical presentation • Presentation of complicated grief symptoms and concurrent trauma symptoms observed to interfere with healthy grief • Evidence for: Prolonged Grief Disorder or Persistent Complex Bereavement Disorder (10-20% of bereaved) 6 3 5/9/2018 Recognizing Traumatic Grief 1 in 20 children in U.S. have a parent die before age 15, (second most frequent type of trauma) many under age three are present at time of a traumatic death* (does not include separations) Children Who Suffer Death Of A Parent Have Higher Mortality Rates Than Others* Intrusive Memories: (e.g. unwanted thoughts, nightmares) Increased Arousal: (e.g. could be irritability, sleep disruption) Avoidance and Numbing(to try to manage distress) Altered Mood and Thoughts (detachment, negative beliefs, distorted thoughts about causes/future,) Not all those w/ CTG will meet full PTSD criteria can still be CTG *NCTSN and PLOS Medicine. 2014 Cultural, Individual Aspects • Grief and loss must be seen via family /cultural view • Talk, emotional expression and behavior after trauma and death varies by family, culture, race, ethnicity and religion • Explored early in treatment (engagement/ Psycho- ed.) helps see reactions outside the expected norms • What might be blocking them from being able to move forward? 8 4
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