5/9/2018
               Enhancing 
               TF-CBT for 
                 Grieving 
               Youth and 
                 Families
                          Dee Bigfoot
                         Roy Van Tassell
       The Many Dimensions of Grief / Loss
      Causes
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       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.
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              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)
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                             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?
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