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CARAWAN-THESIS-2016.Pdf (1.112Mb) DEDICATION I would like to thank the members of my Graduate Committee, my family, and my friends. A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 1 A FAMILY BEREAVEMENT CAMP: EMERGING THEMES REGARDING ITS IMPACT ON THE LIVES OF BEREAVED PARENTS AND SIBLINGS by MELISSA ANNE CARAWAN THESIS PROPOSAL Presented to the Faculty of the School of Health Professions The University of Texas Southwestern Medical Center Dallas, Texas In Partial Fulfillment of the Requirements For the Degree of MASTER OF CLINICAL REHABILITATION COUNSELING A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 2 Copyright © 2015 by MELISSA ANNE CARAWAN All Rights Reserved A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 3 Abstract BACKGROUND: Within the grief literature, family bereavement camps have yet to be researched in a combined population of bereaved parents and siblings. Camp Sol is a weekend retreat for families who have experienced the death of a child/sibling. The goal of the current study is to establish areas reported by parents and sibling campers as being impacted by their experience at camp in hopes of identifying standardized measures that can be implemented in the future evaluation process. This will provide future researchers the ability to quantitatively evaluate the overall efficacy of a family bereavement camp among bereaved parents and siblings. SUBJECTS: Camp Sol evaluations were collected post-camp over the span of five and a half years totaling 656 evaluations. Parents comprised 50.2% of the sample, where the majority of them spoke English versus Spanish (81.4% vs. 18.5%). The children comprised 49.8% of the sample and ranged from the age of 4 to 19. METHOD: Data coding and analysis followed a mixed-methods design, specifically the convergent parallel design, which utilizes both qualitative and quantitative data. The constant Comparative Method (CCM) was used to analyze and code the qualitative portion of the evaluation to arrive at core themes. A variety of quantitative analyses (independent t-test, ANOVA, MANOVA) was used to analyze potential differences between groups according to family role, language, and age. RESULTS: The prominent themes that emerged from the qualitative data were social support, communication, continuing bonds as a coping skill, increased knowledge of the grief process, adjustment, family interaction, and camp environment. Quantitative results revealed that fathers rated the Understanding Index significantly lower than unspecified parents, and siblings’ ages 8 A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 4 to 11 and 12 years and older had significantly higher mean scores on communication than siblings’ ages 2 to 7. DISCUSSION: This study is the first to research both parent and sibling benefits of a family bereavement camp, which identified the importance of non-pathological constructs (e.g. social support, communication, family relationships) while providing richness of information about how a uniquely structured camp may facilitate positive adjustment and coping for entire bereaved families. The camp structure may provide cost effective and accessible grief intervention for bereaved families (English and Spanish) in a safe and supportive environment. Future research would benefit from the use of pre- and/or post- intervention measures assessing for social functioning and mental health, as well as the implementation of a control group to allow discrimination of participants’ outcomes. Keywords: bereaved, grief, parent, sibling, family, interventions, camp, bereavement, effectiveness, social support, communication, knowledge, continuing bonds, adjustment, coping skills, Spanish. A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 5 TABLE OF CONTENTS CHAPTER ONE: INTRODUCTION ………………………………………………... 9 CHAPTER TWO: REVIEW OF THE LITERATURE …………………………..……... 13 Expression of Grief Among Bereaved Parent and Siblings ………………….….. 13 Parent Grief Experiences ….…………………...…………………………. 14 Sibling Grief Experiences ……...………………………….………………. 18 Grief Interventions and Their Effectiveness ……………………………………... 20 General Grief Interventions ……………………………….………………. 20 Parent Grief Interventions ……………………………....…………………. 23 Child Grief Interventions ………………………………...…….…………. 26 Family Grief Interventions ……………………….………..………………. 30 Bereavement Camp Interventions ………………………………………… 36 Latino Grief and Cultural Perspective ……………………………………... 44 Current Study ……………………………………………….…………………… 45 CHAPTER THREE: METHOD …………..……………………….……………………… 49 CHAPTER FOUR: RESULTS …………………………………………………………… 56 Qualitative Results ……………………………………..……………………. 56 Quantitative Results ……………………...……………………………………... 82 CHAPTER FIVE: DISCUSSION …………………………………….……………………. 86 REFERENCES ……………………………………………………………………………… 99 A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 6 LIST OF TABLES TABLE 1 ………………………………………………..…….………………………….. 109 TABLE 2 ………………………………………………..…….………………………….. 110 TABLE 3 ………………………………………………..…….………………………….. 111 TABLE 4 ………………………………………………..…….………………………….. 112 TABLE 5 ………………………………………………..…….………………………….. 116 TABLE 6 ………………………………………………..…….………………………….. 120 TABLE 7 ………………………………………………..…….………………………….. 123 TABLE 8 ………………………………………………..…….………………………….. 127 TABLE 9 ………………………………………………..…….………………………….. 128 TABLE 10 ………………………………………………..…….………………………….. 131 A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 7 LIST OF FIGURES FIGURE 1 ……………………………………………….……………………………..….. 132 FIGURE 2 ……………………………………………….………..……………………….. 133 A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 8 LIST OF APPENDICES APPENDIX A ………………………………………….……………………………….. 134 APPENDIX B ………………………………………….……………………………….. 137 APPENDIX C ………………………………………….……………………………….. 139 APPENDIX D ………………………………………….……………………………….. 154 APPENDIX E ………………………………………….……………………………….. 169 APPENDIX F ………………………………………….……………………………….. 185 APPENDIX G ………………………………………….……………………………….. 193 APPENDIX H ………………………………………….……………………………….. 237 APPENDIX I ………………………………………….……………………………….. 249 APPENDIX J ………………………………………….……………………………….. 256 APPENDIX K ………………………………………….……………………………….. 266 APPENDIX L ………………………………………….……………………………….. 272 A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 9 CHAPTER ONE Introduction According to the Centers for Disease Control and Prevention, approximately 67,800 children between the ages of 0 and 19 died in the United States in 2013, leaving thousands of parents and siblings to experience the natural reactions to death: bereavement and grief. Bereavement is commonly used in reference to the state of experiencing a loss (Rando, 1995). In comparison, grief includes the involuntary reactions of being bereaved, which may include emotional, cognitive, behavioral, physical, and/or spiritual responses to the death (Ziosook & Shear, 2009; Rando, 1995; Servaty-Seib, 2004). Bereaved individuals differ in how they express grief and cope with loss, which is suggested to be related to various circumstances around the death such as cause of death and/or time since death (Murray, 2002). While many stage theories have been developed to describe how different grief reactions may manifest, Miles (1985) developed a phase theory to specifically describe grief reactions among bereaved parents. In contrast, sibling grief reactions may be better conceptualized by utilizing Piaget’s (1967) stages of cognitive development rather than grief stage theories because of the significant impact developmental age has on the grieving process (Herberman Mash, Fullerton, & Ursano, 2013). The efficacy of parent, sibling, and family grief interventions, as well as bereavement camps, has yet to be determined due to inconclusive study results resulting from inconsistent use of long-term outcome measures, small sample sizes, and the simple descriptive nature of many publications. Regarding parental grief interventions, one factor potentially contributing to inconsistent results or a lack of demonstrated effectiveness is the focus on outcomes measured by changes in complicated grief symptoms or psychopathology. The majority of bereaved parents are not experiencing high levels of distress or symptoms that are associated with complicated A FAMILY BEREAVEMENT CAMP AND EMERGING THEMES 10 grief (McCarthy, Clarke, Lin Ting, Conroy, Anderson, & Heath, 2010; van der Houwen, Schut, van den Bout, Stroebe, Stroebe, 2010; Bonanno & Kaltman, 2001; Lichtenthal, Currier, Neimeyer, & Keesee, 2010; Piper et al., 2001; Aoun, Breen, Howting, Rumbold, McNamara, & Hegney, 2015); therefore, it may be unlikely that researchers will see improvements in the measured outcomes if parents are experiencing low levels of distress prior to the intervention. Information regarding the distress levels of bereaved siblings is minimal because the majority of articles outlining common grief reactions of children do not focus on psychopathological functioning. Conversely, the literature provides information on the social functioning of children following the death of a sibling. Scholars have reported common manifestations of grief between some of the developmental stages including behavioral issues and difficulties with communication between family members, both of which may result in strain on the parent-child relationship (Barrera et al., 2013; Dowdney, 2005; Lyles, 2004; Lancaster, 2011; Gibbons, 1992; Wender, 2012; McCown & Davies, 2001; Heiney, 1991). Primarily, studies of child grief interventions have measured psychopathological symptoms (prolonged grief disorder, posttraumatic stress disorder, as well as emotional functioning) but have not found consistent change in these areas, whereas social functioning has been infrequently measured (Pfeffer
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