title: Treating maladaptive grief and posttraumatic stress symptoms in orphaned children in Tanzania: group-based trauma-focused cognitive-behavioral therapy.
abstract: This study was designed to test the feasibility and child clinical outcomes for group-based trauma-focused cognitive behavior therapy (TF-CBT) for orphaned children in Tanzania. There were 64 children with at least mild symptoms of grief and/or traumatic stress and their guardians who participated in this open trial. The TF-CBT for Child Traumatic Grief protocol was adapted for use with a group, resulting in 12 weekly sessions for children and guardians separately with conjoint activities and 3 individual visits with child and guardian. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary child outcomes assessed were symptoms of grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pretreatment, posttreatment, and 3 and 12 months after the end of treatment. Results showed improved scores on all outcomes posttreatment, sustained at 3 and 12 months. Effect sizes (Cohen's d) for baseline to posttreatment were 1.36 for child reported grief symptoms, 1.87 for child-reported PTS, and 1.15 for guardian report of child PTS.
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Center for Child and Family Health, Durham, North Carolina, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: O'Donnell
authors.forename: Shannon
authors.initials: S
authors.lastname: Dorsey
authors.forename: Wenfeng
authors.initials: W
authors.lastname: Gong
authors.forename: Jan
authors.initials: J
authors.lastname: Ostermann
authors.forename: Rachel
authors.initials: R
authors.lastname: Whetten
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cohen
authors.forename: Dafrosa
authors.initials: D
authors.lastname: Itemba
authors.forename: Rachel
authors.initials: R
authors.lastname: Manongi
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001293:Attitude to Death; D002648:Child; D054540:Child, Orphaned / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006117:Grief; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D007872:Legal Guardians / Q000193:education / Q000523:psychology*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011615:Psychotherapy, Group / Q000379:methods; D036301:Qualitative Research; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D013636:Tanzania / Q000453:epidemiology