title: The effectiveness of Grief-Help, a cognitive behavioural treatment for prolonged grief in children: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  There is growing recognition of a syndrome of disturbed grief referred to as prolonged grief disorder (PGD). PGD is mostly studied in adults, but clinically significant PGD symptoms have also been observed in children and adolescents. Yet, to date no effective treatment for childhood PGD exists. The aims of this study are: (1) to investigate the effectiveness of Grief-Help, a nine-session cognitive-behavioural treatment for childhood PGD, combined with five sessions of parental counselling, immediately after the treatment and at three, six and twelve months follow-up; (2) to examine tentative mediators of the effects of Grief-Help, (i.e., maladaptive cognitions and behaviours and positive parenting), and (3) to determine whether demographic variables, child personality, as well as symptoms of PGD, anxiety, and depression in parents moderate the treatment effectiveness.
  
  
  METHODS
  We will conduct a Randomised Controlled Trial (RCT) in which 160 children and adolescents aged 8-18 years are randomly allocated to cognitive behavioural Grief-Help or to a supportive counselling intervention; both treatments are combined with five sessions of parental counselling. We will recruit participants from clinics for mental health in the Netherlands. The primary outcome measure will be the severity of Prolonged Grief Disorder symptoms according to the Inventory of Prolonged Grief for Children (IPG-C). Secondary outcomes will include PTSD, depression and parent-rated internalizing and externalizing problems. Mediators like positive parenting and maladaptive cognitions and behaviours will be identified. We will also examine possible moderators including demographic variables (e.g. time since loss, cause of death), psychopathology symptoms in parents (PGD, anxiety and depression) and child personality. Assessments will take place in both groups at baseline, after the treatment-phase and three, six and twelve months after the post-treatment assessment.
  
  
  CONCLUSIONS
  We aim to contribute to the improvement of mental health care for children and adolescents suffering from loss. By comparing Grief-Help with supportive counselling, and by investigating mediators and moderators of its effectiveness we hope to provide new insights in the effects of interventions for bereaved children, and their mechanisms of change.
  
  
  BACKGROUND
  Netherlands Trial Register NTR3854.
authors.affiliation: Department of Child and Adolescent Studies, Utrecht University, PO Box 80140, Utrecht, TC 3508, The Netherlands. M.Spuij@uu.nl.
authors.forename: Mariken
authors.initials: M
authors.lastname: Spuij
authors.forename: Peter
authors.initials: P
authors.lastname: Prinzie
authors.forename: Maja
authors.initials: M
authors.lastname: Dekovic
authors.forename: Jan
authors.initials: J
authors.lastname: van den Bout
authors.forename: Paul A
authors.initials: PA
authors.lastname: Boelen
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D002648:Child; D002652:Child Behavior; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D006117:Grief; D006801:Humans; D008603:Mental Health; D009426:Netherlands; D010287:Parent-Child Relations; D016487:Parenting; D010290:Parents / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome