The proposed competing renewal is a 15-year follow-up of 244 young adults, in 156 families, who participated in an experimental evaluation of the Family Bereavement Program (FBP), a preventive intervention for parentally-bereaved children. The FBP was provided in childhood and adolescence and the follow-up will occur in young adulthood. Families were randomly assigned to the FBP or a self-study control condition. The FBP program includes a component for parents/caregivers and children and was designed to change multiple mediators that are associated with mental health and adjustment outcomes of bereaved children, including effective parenting and children's effective coping. The post-test and 11-month follow-up indicated program efficacy to improve parenting and children's coping, and to reduce internalizing and externalizing problems for girls. The 6-year follow-up, which included 89.3% of the children who were randomly assigned to conditions, found program benefits to reduce teacher and self-reported internalizing and externalizing problems, reduce rates of diagnosed externalizing disorders, reduce intrusive grief, and improve HPA axis regulation, grade point average and self-esteem. FBP also reduced levels of caregiver depression and improved parenting at six-year follow-up. Several program effects in adolescence were moderated by age of child and level of problems at pre-test. Program effects on adolescents at six year follow-up were mediated by improvements in parenting and parents'depressive symptoms at post-test. This application has five specific aims: 1. Evaluate the 15-year efficacy of the FBP on: (a) mental health problems and disorders (b) physical health and health risk behaviors and (c) developmental competencies (e.g., educational and vocational success). 2. Expand the evaluation of 15-year outcomes to include focused, multi-method evaluation of emotion regulation skills (i.e., attentional control, active coping, cognitive reappraisal, and use of social support), assessed through self-report surveys, daily diaries, and cognitive, behavioral, and physiological responses to "real-time" cognitively and interpersonally stressful tasks. 3. Examine whether the 15-year outcomes of the FBP are moderated by baseline youth factors, including gender, age, and pre-intervention psychosocial risk. 4. Evaluate a longitudinal mediation model hypothesizing that intervention effects in young adulthood are mediated by program-induced effects on positive parenting and youth outcomes at 6-year follow-up. 5. Conduct an economic analysis of FBP's impact over the 15-year follow-up period. The proposed research is consistent with the NIMH strategic plan to assess intervention effects on a broad trajectory of outcomes including mental disorder, adaptive functioning and improvements in neurophysiological response to stress in a high risk sample of bereaved children (NIMH, 2008).
While the death of a parent is a traumatic event that elevates children's risk for multiple mental health problems and disorders, there is little evidence to support the effectiveness of interventions with this population. The current application is an evaluation of the long-term effects of the Family Bereavement Program, one of the very few preventive interventions with bereaved children that have shown evidence of effectiveness in a rigorous randomized experimental trial. The follow-up has great public health significance to demonstrate the potential impact of the program as children reach young adulthood, to assess the cost-effectiveness of the intervention and to better identify who is most likely to benefit from the program.
|Schoenfelder, Erin N; Tein, Jenn-Yun; Wolchik, Sharlene et al. (2015) Effects of the Family Bereavement Program on academic outcomes, educational expectations and job aspirations 6 years later: the mediating role of parenting and youth mental health problems. J Abnorm Child Psychol 43:229-41|
|Luecken, Linda J; Hagan, Melissa J; Sandler, Irwin N et al. (2014) Longitudinal mediators of a randomized prevention program effect on cortisol for youth from parentally bereaved families. Prev Sci 15:224-32|
|Sandler, Irwin N; Wolchik, Sharlene A; Ayers, Tim S et al. (2013) Family Bereavement Program (FBP) Approach to Promoting Resilience Following the Death of a Parent. Fam Sci 4:|
|Schoenfelder, Erin N; Sandler, Irwin N; Millsap, Roger E et al. (2013) Caregiver responsiveness to the family bereavement program: what predicts responsiveness? What does responsiveness predict? Prev Sci 14:545-56|
|Hagan, Melissa J; Tein, Jenn-Yun; Sandler, Irwin N et al. (2012) Strengthening effective parenting practices over the long term: effects of a preventive intervention for parentally bereaved families. J Clin Child Adolesc Psychol 41:177-88|
|Schoenfelder, Erin N; Sandler, Irwin N; Wolchik, Sharlene et al. (2011) Quality of social relationships and the development of depression in parentally-bereaved youth. J Youth Adolesc 40:85-96|
|Sandler, Irwin N; Ma, Yue; Tein, Jenn-Yun et al. (2010) Long-term effects of the family bereavement program on multiple indicators of grief in parentally bereaved children and adolescents. J Consult Clin Psychol 78:131-43|
|Hagan, Melissa J; Roubinov, Danielle S; Gress-Smith, Jenna et al. (2010) Positive parenting during childhood moderates the impact of recent negative events on cortisol activity in parentally bereaved youth. Psychopharmacology (Berl) :|
|Little, Michelle; Sandler, Irwin N; Wolchik, Sharlene A et al. (2009) Comparing cognitive, relational and stress mechanisms underlying gender differences in recovery from bereavement-related internalizing problems. J Clin Child Adolesc Psychol 38:486-500|
|Wolchik, S A; Sandler, I N; Jones, S et al. (2009) The New Beginnings Program for Divorcing and Separating Families: Moving from Efficacy to Effectiveness. Fam Court Rev 47:416-435|
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