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Developing and Implementing a Bereavement Support Program for College Students a

b

Cynthia L. Battle , Joseph A. Greer , Samia Ortizc

Hernández & David M. Todd

d

a

Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University, Butler Hospital Psychosocial Research Program , Providence , Rhode Island , USA b

Harvard Medical School , Center for Psychiatric Oncology & Behavioral Sciences, Massachusetts General Hospital Cancer Center , Boston , Massachusetts , USA c

Department of Psychology , George Washington University , Washington , DC , USA d

Department of Psychology , University of Massachusetts Amherst , Amherst , Massachusetts , USA Accepted author version posted online: 21 Dec 2012.Published online: 19 Feb 2013.

To cite this article: Cynthia L. Battle , Joseph A. Greer , Samia OrtizHernández & David M. Todd (2013) Developing and Implementing a Bereavement Support Program for College Students, Death Studies, 37:4, 362-382, DOI: 10.1080/07481187.2011.634087 To link to this article: http://dx.doi.org/10.1080/07481187.2011.634087

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Death Studies, 37: 362–382, 2013 Copyright # Taylor & Francis Group, LLC ISSN: 0748-1187 print=1091-7683 online DOI: 10.1080/07481187.2011.634087

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DEVELOPING AND IMPLEMENTING A BEREAVEMENT SUPPORT PROGRAM FOR COLLEGE STUDENTS CYNTHIA L. BATTLE Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Butler Hospital Psychosocial Research Program, Providence, Rhode Island, USA JOSEPH A. GREER Harvard Medical School, Center for Psychiatric Oncology & Behavioral Sciences, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA ´ NDEZ SAMIA ORTIZ-HERNA Department of Psychology, George Washington University, Washington, DC, USA DAVID M. TODD Department of Psychology, University of Massachusetts Amherst, Amherst, Massachusetts, USA

The death of a loved one can be particularly difficult for college students, as significant losses are not anticipated during this time. Bereavement experiences are, however, not uncommon among college students, and campus environments can be isolating and nonconducive to recovery. To date, few interventions have been developed to meet bereaved college students’ needs. The authors describe the rationale, development, and structure of a campus-based bereavement support program in New England, which provided a series of 17 support groups serving 105 students. They present feedback data from a subset of participants and discuss issues to consider in providing similar on-campus services.

Received 26 May 2011; accepted 10 October 2011. Address correspondence to Cynthia L. Battle, Department of Psychiatry, Butler Hospital Psychosocial Research, 345 Blackstone Blvd., Providence, RI 02906. E-mail: [email protected]

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The death or serious illness of a loved one is generally not anticipated during adolescence or young adulthood (Balk, 1996; Rask, Kaunonen, & Paunonen-Ilmonen, 2002). However, many young people suffer significant losses at this time, and a large proportion of them are living in college environments. For example, in an early study, 29% of 2,049 college students had experienced a recent death of a close loved one (LaGrand, 1982). More recently, nearly one-third of 1,000 undergraduates experienced a family death in the previous 12 months, and 47% had experienced a family death in the previous 24 months (Balk, 1997). In a more rigorously conducted study using advanced stratified sampling, among 118 undergraduates, 22% to 30% were in the first 12 months of bereavement (Balk, Walker, & Baker, 2010). Given these relatively consistent findings of high rates of bereavement experiences among college students, it is not surprising that a broad needs-assessment study conducted by Jennings (1996) showed that a significant percentage of college undergraduates (44%) indicated that there was a ‘‘moderate to very high need’’ for campus bereavement services, making bereavement support one of the strongest areas of concern highlighted in the survey. College students face unique challenges when faced with bereavement. First, from a developmental perspective, a primary developmental task of adolescence is individuation, the process of establishing an autonomous identity separate from parents and other caregivers, while still maintaining a close connection to them. Thus, death of parents or other caregivers is one type of loss that can be particularly challenging for college students (Balk, 1991; Gray, 1987). Indeed, in addition to being physically distanced from parents during the college years, many young people also intentionally create emotional distance from family members at this time. If a parent or another family caregiver dies just as a young person is distancing him or herself to establish a more autonomous identity, the bereaved student may subsequently experience strong feelings of guilt, as well as a deep sense of loss about being unable to reestablish a close relationship with their parent later during their adult years (Janowiak, Mei-Tal, & Drapkin, 1995). In addition to parental losses, other types of losses can be similarly difficult for adolescents and young adults who may be developmentally less accustomed to dealing with mortality and who may experience life stage-related challenges in making sense of these transitions (Servaty-Seib & Taub, 2010).

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Second, university and college environments are particularly nonconducive to recovery from loss (Balk, 2001; Berson, 1988). A bereaved student’s loneliness and isolation may be amplified by physical distance from family and friends, as well as by being surrounded by young people who themselves have had little experience with death and dying (Balk, Tyson-Rawson, & CollettiWetzel, 1993). Moreover, in many campus settings, students spend much of their nonacademic time socializing and having fun with peers, often leading to a ‘‘party-oriented’’ atmosphere from which bereaved students may feel disconnected. Thus, the environment on campus is often not one that naturally lends itself to feeling understood and supported, and this lack of perceived (and actual) support may create problems in a young person’s recovery from loss. As noted by Gray (1987), adolescents with limited social support are significantly more likely to experience elevated depression following a loss. Indeed, bereaved students often report an acute sense of isolation (Tedeschi & Calhoun, 1993), believing their experience is not normal, and no one in their environment understands—or even could understand. Third, college students often face considerable pressure to achieve—not only to make good grades, but also to make progress in decisions regarding a future career and obtaining the academic background and practical skills to be successful in that field. Moreover, an increasingly large proportion of college students are employed in part-time jobs, often working many hours per week to help defray tuition and living costs. According to recent U.S. statistics (Aud et al., 2010), in 2008, 45% of full-time and 79% of part-time college students were employed while also going to school, with most of these students working well over 20 hours per week. As such, students are typically juggling multiple important demands, often while removed from their family and home support network. The profound and unexpected stress of experiencing the death of a loved one can therefore not only impact one’s emotional state, but also take a toll on concentration and academic functioning (Servaty-Seib & Hamilton, 2006; Balk, 2001). In addition, recent reports have suggested that bereaved students frequently suffer significant sleep disruption and insomnia compared to their nonbereaved peers (Hardison, Neimeyer, & Lichstein, 2005). Compounding this difficulty is the fact that students may not discuss their loss experience with faculty members or others

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in the campus environment or may not disclose the extent to which they are experiencing trouble with schoolwork and overall functioning. Although some students opt to take time off from classes if a loved one dies or becomes very ill, such decisions can be complicated given pressures to complete coursework on schedule, and concerns about additional costs of extending one’s time in achieving a degree. Although bereavement is not uncommon among college students and comes with unique challenges, few therapeutic interventions have been evaluated empirically for this population (Balk, 2001; Tedeschi, 1996). Moreover, young people often do not seek out traditional college counseling or psychotherapy services to assist them in recovering from loss (Rickgarn, 1996), possibly due to the stigma associated with mental health care and mental illness (Fleming & Adolph, 1986). Although some bereaved students may find support in talking to other students and friends on campus, many of their young peers lack the skills needed to provide support. Indeed, when hearing that a friend has had a serious loss it is not uncommon for the response to be avoidance rather than support (Balk, 2001). Some college bereavement support interventions have been described in the literature such as counseling services and grief workshops (e.g., Janowiak et al., 1995; Jennings, 1996; Vickio, 2008). A peer-support organization for bereaved college students (National Students of AMF) has also developed a presence on some college and university campuses. Yet a decade after Balk (2001) issued a call to action urging universities to provide greater resources and infrastructure to support grieving students, most campuses still lack such programs, and an unmet need exists.

Reflect: A Campus-Based Bereavement Support Program We present a model for supporting bereaved students that was successfully implemented on a campus setting, ultimately serving over 100 students. The program, entitled Reflect, consisted of structured bereavement support groups, informal drop-in workshops on coping with loss, resource and referral services, and awarenessraising on campus. Support groups and all other services were

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provided at no cost to students. Reflect program services were located on the campus of a large university in New England and welcomed participation from students enrolled at several other nearby colleges. In the following sections, we detail initial program development efforts, the goal, content, and structure of the program, and feedback from support group participants. We also describe how facilitation of bereavement support groups provided a clinical training opportunity for advanced psychology graduate students, and close by presenting issues to consider in developing a similar on-campus program. Initial Program Development Although a rationale for providing bereavement support for students is clearly apparent from the empirical literature, the motivation for developing the Reflect program did not originate from researchers and professionals in the field. Rather, the program came into being as a result of students on campus voicing their need for bereavement support. The first bereavement group was offered when a recently bereaved undergraduate student was unable to find an outlet for talking with others regarding his loss. When he found that no support groups or other bereavement resources were available on campus, he posted flyers and began a peer-led, drop-in support group to seek connections with other bereaved students. After offering a series of informal drop-in sessions in the university campus center, he sought help in leading the group from members of the clinical psychology doctoral program on campus. Two clinical psychology doctoral students soon became involved, each taking the role of facilitating a structured bereavement support group for students on campus. Simultaneously, based upon the student’s initial awarenessraising efforts highlighting the lack of services on campus, the university’s polling office conducted a phone-based campus-wide needs assessment. This independent campus research group, separate from the Reflect program, surveyed undergraduates regarding the need for bereavement services on campus. A random sample of 673 current university students were telephoned, and the majority of those called (n ¼ 608) participated in a brief interview. Participants were asked (a) whether they had been affected by the death, serious illnesses, or life-threatening accident of a

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loved one since going to college, and if so (b) what type of campus resources they used to cope with their grief. Finally, all students were asked (c) what type of campus services would be helpful in coping with grief should the need arise. The report from the campus phone survey (Oronato, 1995) noted that one-third of students polled reported the death of a loved one since going to college, and about one-fourth reported the serious illness=accident of loved one. Overall, 9% of students (n ¼ 54) reported taking a leave of absence from school as a result. These survey results underscored the widespread nature of campus bereavement as well as the importance of ensuring the appropriate services were offered to students in need. The Dean of Students’ office on campus, which promotes student development and assists students and their families during crisis, became committed to supporting the developing Reflect program. Funds to help operate the program were raised by seeking donations from university alumni. The program was refined and expanded in the subsequent years, led by clinical psychology doctoral students, and supported by both the Dean of Students office and the Department of Psychology. Private, comfortably furnished space was provided for support group meetings by the Department of Psychology within the Clinical Psychology training clinic. The Reflect program was advertised via widespread outreach at five area colleges and universities. Ultimately, the program grew to include not only structured support groups led by doctoral students but also informational drop-in workshops, and referral services. The origin of the Reflect program, arising from student’s needs and concerns, remained central to the spirit and mission of the program. As the program grew, the clinical psychology graduate students who were initially involved trained other clinical graduate students to lead subsequent support groups, with the oversight of a licensed psychologist in the Department of Psychology. Although groups were organized and facilitated by psychology professionals-in-training (rather than as peer-led self-help groups), we sought to maintain our grounding as a community-oriented program that had been initiated by a nonprofessional seeking to build community with other students. Thus, the group established itself as a collaborative effort between students who initially founded the program, faculty in the Psychology Department who provided space and clinical

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guidance, and administrators in the Dean of Students Office who provided funding and administrative oversight.

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Program Goals, Structure, and Content The overall goal of the Reflect program was to help students experience bereavement in a healthy and supported way and to begin to accept the reality of their loss and integrate it in a meaningful way into their lives, concepts consistent with the work of Neimeyer (2002). We emphasized breaking through the isolation that many young bereaved people in college experience. The core service that students received through Reflect was access to structured weekly support groups. These groups had three interrelated goals: (a) to promote social support by connecting students with others who had suffered a loss, (b) to provide psychoeducation and normalization regarding common bereavement experiences to help students identify and understand their feelings, and (c) to create an opportunity for students to remember and memorialize the loved one who died. Ultimately, we hoped these groups provided students with empathy, support, acknowledgment of their losses, and a chance to reminisce—experiences Corrazzini and May (1985) proposed as key to healing. Reflect bereavement groups were structured as small, confidential, facilitated, support groups. We used a closed group format such that all participants in a given group started attending on the same day and met consistently each week for 90-minute sessions. Most groups took place in the early evening, as this time was most requested by students. The majority of groups were led by a single facilitator. Participants were asked at the outset of the group to make a commitment to attend all sessions in the series. Although most groups focused on bereavement following a death, a few specialized groups were offered that focused on coping with the terminal illness of a loved one. Initially, groups met for 6 consecutive weeks; however, early in the program’s development the format was changed in response to participant feedback, and the series was extended to eight weeks. Each group was limited to eight participants, and on average four to five participants enrolled per group. Participants learned about the Reflect groups in a variety of ways, including flyers, newspapers ads, articles in local newspapers, and referrals from residence hall staff, health services

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staff, and campus mental health clinicians. A dedicated phone line was established for the program to receive inquires regarding Reflect groups and other services. All individuals who called to express interest in joining one of the support groups were initially prescreened to determine whether the support group was appropriate for their current needs and to assess their personal goals for involvement. In some cases, individuals were referred for services elsewhere, typically if the meeting time did not suit their schedule, or if they were concerned about the group-based format. Reflect group facilitators were second- to fifth-year doctoral students in a clinical psychology PhD program, or PhD-level therapists enrolled in a clinical psychology respecialization program. The majority of facilitators did not have prior experience in working with bereaved individuals; however, some had experienced prior losses themselves. Facilitators were not paid; they volunteered their time to lead the support groups. Training was provided by a licensed faculty member in the Psychology Department and by the Reflect coordinator, who was an advanced doctoral student who had experience running Reflect groups. Weekly supervision was provided by the Reflect coordinator; consultation was provided by a licensed psychologist on faculty, as needed. See Table 1 for an overview of the week-by-week session content of the Reflect support groups. Each eight-session series followed a similar format; however, we incorporated flexibility into the design so that facilitators and group members were able to tailor the focus of the sessions to best suit participants’ needs. In addition, though each group session had a particular focus for that week, all sessions (except Session 1; Introductions) began with group members briefly sharing how they have been doing over the past week, particularly in terms of coping with their loss. Session 1 oriented and welcomed participants to the group, with an additional goal of establishing trust and rapport with one another and the group facilitator. Because some participants find self-disclosure challenging within a new group setting, we used a paired introduction exercise to help participants feel more comfortable as they began to share the story of the loss that prompted group involvement. After providing a general introduction to the format and of the group, and discussing guidelines for participation, facilitators asked that group members break up into pairs for about 10–15 minutes. During the paired exercise, participants

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Psychoeducation re: bereavement Challenge of bereavement in a campus environment

Sharing of personal stories

Sharing of personal stories

Sharing of personal stories

Week 2

Week 3

Week 4

Week 5

Week 1

Individual prescreening of group participants Introductions

General focus

Prior to Week 1

Week

. . . . . . . .

. . .

. . . . . . . . .

Specific group content and activities

Participant intake & consent forms Facilitator & participant introductions Discussion of group format, content, guidelines Disclosure in pairs; re-introduction of partners Orientation to future sessions; sharing personal stories Introduce journal writing as an option Check-in Discussion of various models of grief= handouts Group participants reflect on their experiences, find differences and commonalities Education and normalization regarding reactions to loss Discuss challenges of grieving in a campus setting Make plans for sharing personal stories (Weeks 3–5) xMake plans for sharing personal stories (Weeks 3–5) Check-in Participants share in-depth stories of their loss Photographs, poetry and other meaningful items often shared with the group Check-in Personal stories (as above) Note group’s half-way point Check-in Personal stories (as above)

TABLE 1 Week-by-Week Content of Reflect Bereavement Groups

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Flexible topic

Flexible topic

Group closure

Reunion group meeting

Week 6

Week 7

Week 8

6–8 weeks after group ends

by facilitator:  Impact of bereavement on relationships  Letter writing exercise  Strengthening support from family=friends  Interacting w= nonbereaved peers on campus . Check-in . Participants choose to focus on a topic= activity from several options presented by facilitator (as above) . Discuss plans for last group session . Check-in . Discussion of letter-writing experiences; some may opt to share content of letter . Reflections on being in the group . Finalize plans for a group reunion (if applicable) . Informal, unstructured gathering, usually sharing a meal . Opportunity for participants to share about their experiences of being in the group, and how they have been since the group’s ending

. Check-in . Participants decide on a topic=activity, possibly from several options presented

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shared some information about their backgrounds (year in school, area of study, hometown, etc.), and, to the extent that they felt comfortable, their reasons for wanting to participate in the bereavement group. Upon reconvening the larger group, group participants introduced their partners, and shared a few details about them. Participants seemed to enjoy this exercise; it usually allowed individuals to form quickly a one-on-one connection with another group participant. For those who find it hard to share in a group setting, or who were particularly concerned about disclosing their loss to a group of strangers, the exercise relieved some pressure from initial introductions. During Session 1, the facilitator discussed the content of subsequent group sessions, including an overview of the focus for Sessions 3–5, Sharing Personal Stories. In addition, the facilitator introduced journal-writing as a potentially helpful exercise during the course of group participation and provided a handout to participants regarding approaches to use when journaling about one’s experiences with loss. Session 2 focused on psycho-education regarding bereavement, with the twofold goal of educating participants and providing a sense of normalization for the broad range of experiences encountered by bereaved individuals. Several informational handouts were used to introduce participants to various concepts, primarily the wide range of emotions and physical symptoms a bereaved person may experience, as well as how a major loss experience can influence family relationships, friendships, and relationships with peers. We introduced ideas regarding self-care behaviors, interpersonal behaviors, and other coping strategies that may be helpful, and participants also shared what had been helpful to them. Many participants entered the group with little information or understanding of how the death of a loved one can affect a person. Others shared their misperception (or misperception of others) that grief following loss only lasts a relatively short period. Another common discussion point was the notion that bereaved individuals typically follow a universal series of stages in response to a loss. Group participants were frequently relieved to learn that, as noted by Vickio (2008), there is great diversity in how grief is experienced: Bereaved individuals may experience very different emotions, the timeframe for recovery can vary from person to person, and there are no universal stages of grief.

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Another topic typically raised during the second group session included difficult interactions with nonbereaved individuals. Participants often voiced concerns, frustrations, and disappointments with regard to how their friends, classmates, and others responded following their loss. Although some students reported feeling very supported by peers, it was not uncommon for participants to describe experiences in which friends and peers were silent in response to their loss, failing to acknowledge it. Another experience that group members frequently voiced was that friends made unhelpful (or even unintentionally hurtful) remarks to them following their loss. Thus, for many of our participants, who had traditionally relied on their friend and peer relationships, there was often a sense of disappointment at not receiving sufficient support in the college environment from those with whom they spent the majority of their time. In the second group session and again in subsequent sessions, members often helped each other consider strategies for talking about their loss with others, and how to ask for support from individuals in their social network who may be unfamiliar with bereavement or how to help a grieving friend. Sessions 3, 4, and 5 each allotted a significant portion of time for sharing about the person who died. Prior to these sessions, we prepared participants for this experience by discussing the rationale, providing a handout with suggestions for ‘‘sharing your story,’’ and talking about various ways that group members can approach their process of telling the story. In some cases, participants opted to focus on sharing details of the person’s life, including the loved one’s background, accomplishments, unique personal qualities, and the impact that this person had on others. Other times, group members focused more on their relationship with the loved one who died, and their emotional experience of loss regarding that person’s death. We emphasized that there was not a right way to tell the story. If a participant found it difficult to prepare a story in advance, he=she could opt to have other group members facilitate the telling of the story by asking them questions about the person who died, which allowed for an in-depth story to be told through a more informal conversation. Often group members brought photographs, sentimental objects, music, scrapbooks and other items to facilitate their process of telling the story. Sessions 6 and 7 could focus upon a flexible topic determined by the interests and needs of the group. The week before these

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sessions, group facilitators asked participants about their interests, and also suggest possible topics for participants to consider. Some common topics that were addressed in these group sessions included (a) discussing the impact of loss and bereavement on family roles and relationships; (b) completing a letter-writing exercise, in which participants drafted letters to the loved one who died, and optionally shared the letter with the group; (c) examining ways to increase support from family and friends; and (d) coping with bereavement on campus and strategies for coping with nonbereaved peers on campus. Session 8 was the final group session. After the weekly check-in at the beginning of the session, participants shared reflections regarding their experience of being in the group and discussed what they expected with respect to their longer-term coping process, after the group ended. Ample time was also spent saying goodbye and sharing reactions with one another that had not previously been shared in the context of the group. The format was intentionally left open so participants had sufficient opportunities to bring up topics or reactions they previously had not had a chance to share. At this final session, the facilitator encouraged the group members to make plans for holding an optional, participant-led ‘‘reunion’’ gathering approximately 6–8 weeks after the ending of the group. Although optional, nearly all Reflect groups opted to hold a reunion gathering; these gatherings were not held in the same space as the weekly sessions on campus, and they were organized by group members rather than the facilitator. The reunion provided a useful transition from being actively in the group to graduating from the group. Given that groups focused on loss, and most participants formed an emotional bond with others in the group, providing an opportunity for a relaxed, informal reunion later seemed to ease the experience of saying goodbye at the final session. Participant Feedback Over a 4-year period, 17 campus-based bereavement support groups were conducted, serving approximately 105 students who experienced loss due to either the death of a loved one (14 groups) or the serious illness of a loved one (3 groups). The majority of participants were undergraduates; however the groups were open

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to all students on campus and graduate students would occasionally enroll. Enrollment and retention were very good, with a demand for two to three support groups per semester. Typically four to eight students were prescreened for a given group series. The majority of these prescreened students ultimately enrolled and continued to participate regularly at each session until the group ended. In addition, the majority of groups chose to convene an optional reunion gathering after the official series of sessions had completed. In an effort to evaluate and improve upon Reflect bereavement groups, we asked participants to provide feedback regarding their experience using a brief, optional, and anonymous questionnaire. Feedback forms were kept brief and anonymous and did not include demographics or identifying information. Questions on the form assessed several logistical elements of the group (time, location, size and length, etc.). In addition, we asked for openended feedback regarding elements of the group that were helpful or unhelpful and suggestions for improvement. Because the form was optional and required additional effort for its anonymous return, a limited subset of completed forms was available for review. Ultimately 20 complete participant feedback forms, representing seven Reflect bereavement groups and six facilitators, were available. We obtained Institutional Review Board approval to summarize these data. Among the feedback forms available for review, participants viewed the bereavement support groups as highly acceptable. In fact, in response to open-ended questions regarding whether the program was beneficial, 100% of students in our sample noted that the group had helped them cope with their bereavement. In terms of logistics of the groups, the vast majority of respondents reported satisfaction with the timing, size, and location of the group meetings. To interpret respondents’ open-ended narrative comments, we used an editing-organizing style of qualitative data analysis (Crabtree & Miller, 1999). As the first step in a two-part process, two authors (Cynthia L. Battle and Samia Ortiz-Herna´ndez) read a subset of feedback forms and independently developed a categorization system for coding participant comments. These two categorization systems were compared and differences were collaboratively resolved so that a final codebook with descriptive

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examples could be created. This codebook contained 20 different categories across three major domains (helpful aspects of the group, suggestions for improvement, and other comments). Once the final coding system was established, the same two authors independently assigned codes to all written comments on the feedback forms. These independent ratings were compared and any coding differences were discussed until consensus was reached. By the end of this process, agreement was achieved regarding every code assigned to each of the comments on the forms. The ultimate set of categories and their frequency counts are presented in Table 2. We identified 15 themes relating to helpful aspects of the group, three themes under the heading suggestions for improving the group and two themes that we classified as other comments. TABLE 2 Feedback From Bereavement Group Participants Code Helpful elements of the group Facilitator’s skill or style made the group a helpful experience It helped to meet other bereaved students Others responded with support, understanding, and respect It was a comfortable environment in which to share It helped me to make a commitment to let myself grieve Cozy physical atmosphere (private space, small group, herbal tea) The handouts provided me with helpful information Group discussion increased my understanding of bereavement It helped to hear others’ stories of loss It helped to tell my own story of loss Being in the group made me feel like my experiences were normal I developed trusting relationships, friendships with others It helped that the facilitator had loss experience her=himself All other helpful elements identified Any remark suggesting that the group was helpful Suggestions for improving the group Consider adding more sessions Consider lengthening each session All other suggestions Other comments regarding the group Expressions of gratitude All other comments a

Frequency (%) 17 14 13 12 10 10

(85%) (70%) (65%) (60%) (50%) (50%)

8 5 5 5 5

(40%) (25%) (25%) (25%) (25%)

3 2 2 20

(15%) (10%) (10%) (100%)

13 (65%)a 5 (25%) 6 (30%) 7 (35%) 5 (25%)

Many of these comments were made before the group format was extended to 8 weeks.

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Students identified a relatively broad range of factors that led the group to be helpful. Many respondents made positive comments regarding those who facilitated the groups (e.g., ‘‘[The facilitator] was very easy going and compassionate.’’ ‘‘She was very tuned in to the needs of the group’’). Connecting with other bereaved students was also frequently noted as beneficial: ‘‘[The group] was a common ground for those with similar experiences. I felt less alone; I felt validated.’’ Another remarked: ‘‘It helped speaking with others that have had a loss. I knew they could relate and weren’t afraid of listening to my pain.’’ Understanding, empathic comments from others were also recognized as a factor that helped: ‘‘Being with people who were willing to speak and listen with empathy was moving and helpful.’’ In addition, a number of students noted that one of the most helpful aspects of being in the group was the fact that it involved making a commitment to set aside time to grieve: ‘‘The fact that I finally had an outlet in which I felt it was okay to take time out of my busy life in which to grieve was imperative to my grieving process—I felt it was okay to allow myself to feel, because it was scheduled into my life.’’ Respondents also commonly noted other helpful elements of the experience, for example, meeting in a comfortable, private ‘‘cozy’’ space; receiving psychoeducation regarding bereavement and helpful handouts; hearing others’ in-depth stories of loss; and, sharing their own experiences. Several individuals indicated that the group experience made them feel like their feelings because their loss were normal, and not ‘‘crazy.’’ Finally, a few students reported that one of the best parts of being in the group was that it prompted the development of new close friendships. In terms of suggestions for improvement, most common was a request to extend the group for more weeks or for a longer period of time at each session. Some of these comments were made prior to our decision to extend the group from a six-session to an eightsession format; ultimately, the 8-week format appeared to be more acceptable, with fewer comments to lengthen it. Aside from remarks about elements that helped or suggestions for improvement, the most common other remarks were expressions of gratitude. In addition, a few other comments were made, such as consider adding specialized groups (e.g., bereavement due to suicide). It is important to note that the analysis of the participant feedback data is limited by the relatively small percentage of

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completed forms available for review. It is possible that group participants with stronger and=or more positive opinions were those more motivated to return the forms. However, themes from the analyzed data were quite consistent with the verbal feedback we received from group members over the years. As such, our impression is that data analysis captured the most common types of comments from students who took part in the groups. Opportunities for Clinical Training An additional benefit of the Reflect program beyond the primary goal of providing support services to bereaved college students was providing an important training opportunity for psychology doctoral students. Functioning as a group facilitator not only exposed clinical graduate students to the unique needs of bereaved individuals, but also more broadly, introduced core skills in group facilitation. In addition, for many clinical psychology students, their experience with Reflect differed from most other clinical practica or externships, as it emphasized supporting individuals through a normal grieving process rather than assessing or treating psychopathology. Facilitators in this program often voiced positive comments regarding the value of this training experience and noted ways in which it informed future clinical work. Thus, we observed a mutually beneficial arrangement whereby students received high quality facilitated support groups overseen by a licensed professional—and doctoral students obtained a valuable training experience. Considerations in Implementing a Campus-Based Bereavement Support Program The positive experience we had implementing the Reflect bereavement support program leads us to believe that these services are highly needed, feasible to administer, and greatly appreciated by bereaved college students. Recent work by Balk (2011) underscores the need for such services on campus. Additional empirical research is needed to determine whether this type of campus-based support program is efficacious in addressing the clinical symptoms, distress, and functional impairments experienced by many bereaved students. In addition, long-term follow-up studies are

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needed to examine whether such interventions could potentially have an effect in helping to reduce the likelihood of students experiencing subsequent problems such as prolonged bereavement, depressive episodes, or thoughts of suicide. Although each campus setting is unique and some may not have adequate resources to offer such a program, many do. Following are considerations in establishing a similar program: .

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Needs assessment. Before establishing a new bereavement program for students, consider assessing bereavement support needs and preferences on campus, as well as existing services in place to meet those needs. This initial step can help ensure that the program is integrated well with other services, and not duplicate services provided by existing programs. Collaboration. Early in the development of the program it is useful to build collaboration and enthusiasm among students, faculty, and administrators. Student involvement helps ensure services are in sync with student needs and perspectives. Faculty and administrative guidance provides credibility and clinical wisdom and helps promote continuation year-to-year. An advisory board with representatives from each stakeholder group may be beneficial. Space. Acquire an appropriate space for the program’s services that is convenient and private. Establishing a physical ‘‘home’’ on campus can help promote continuity and increase the legitimacy of the services in the eyes of the community. Staffing. Identify a coordinator to oversee the program and manage recruitment of facilitators, advertising, enrollment of participants, and management of program resources and funds. If applicable, graduate students in psychology, social work, or related health professions can be trained to facilitate groups. Supervision of group facilitators may be provided by campus mental health providers or clinical or counseling psychology faculty. Become a visible campus presence. It is important to promote programs regularly through announcements to relevant campus personnel (residence life staff, dean’s offices, health services, clergy), on-campus flyers, and media announcements. Establish a campus-based phone line and website, preferably separate from campus mental health services. In addition to on-campus

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promotion, it is helpful to conduct outreach with relevant off-campus organizations (hospice, churches, community referral agencies). Becoming a visible presence on and around campus not only helps to advertise bereavement services that are offered by the program, it can also play a critical role in raising general awareness regarding the prevalence of bereavement on campus and the needs of students who have suffered a loss. Funding. Although bereavement support programs can operate on a low budget, some funds or in-kind resources are necessary (e.g., for phone service, photocopying, and ideally, a stipend for the coordinator). Such support could potentially be sought from the mental health services office, the student affairs=dean’s office, alumni organizations or private foundations. Clinical oversight. Involvement of a licensed clinician is advisable. Even though a licensed clinician may not need to provide any direct services, he=she can assist in the development of group prescreening procedures and an appropriate referral list. A licensed clinician is also important to involve during risk assessments and facilitator training. Flexibility to provide specialized services. Our experience offering bereavement support to a wide range of students experiencing a wide range of losses suggested that most of the time, a structured support group format such as the one we used can benefit many. Building flexibility into the groups is essential so it meets needs of those with diverse experiences. If resources are available, specialized groups may be useful for students suffering losses from violent circumstances (suicide, homicide), as these experiences can come with unique challenges in the student’s process of recovery and meaning-making (Neimeyer, Laurie, Mehta, Hardison, & Currier, 2008). Program evaluation. Obtain participant feedback regularly. Develop procedures to evaluate program effectiveness and degree to which the needs of the campus community are met.

Given the enthusiasm we encountered for the Reflect program, it is plausible that similar services may be feasible and well-received on other college campuses. Increased awareness regarding bereaved students’ needs will hopefully provide support to ease the distress and improve functional difficulties encountered by bereaved

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students, and prevent longer-term negative outcomes associated with unresolved grief.

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LaGrand, L. E. (1982). How college and university students cope with loss. In R. A. Pacholski & C. A. Corr (Eds.), Priorities in death education and counseling (pp. 85–97). Arlington, VA: Forum for Death Education and Counseling. Neimeyer, R. A. (2002). Lessons of loss: A guide to coping (2nd ed.). New York, NY: Brunner-Routledge. Neimeyer, R. A., Laurie, A., Mehta, T., Hardison, H., & Currier, J. M. (2008). Lessons of loss: Meaning-making in bereaved college students. New Directions for Student Services, (121), 27–39. doi:10.1002=ss.264 Oronato, S. (1995). Project Pulse: Life-threatening illness and grief survey. Amherst: University of Massachusetts, Student Affairs Research, Information and Systems. Rask, K., Kaunonen, M., & Paunonen-Ilmonen, M. (2002). Adolescent coping with grief after the death of a loved one. International Journal of Nursing Practice, 8, 137–142. doi: 10.1046=j.1440–172X.2002.00354.x Rickgarn, R. L. V. (1996). The need for postvention on college campuses: A rationale and case study findings. In C. A. Corr & D. E. Balk (Eds.), Handbook of adolescent death and bereavement (pp. 273–292). New York, NY: Springer. Servaty-Seib, H. L. & Hamilton., L.A. (2006). Educational performance and persistence of bereaved college students. Journal of College Student Development, 47, 225–234. Servaty-Seib, H. L. & Taub, D. J. (2010). Bereavement and college students: The role of counseling psychology. The Counseling Psychologist, 38, 947–975. Tedeschi, R. G. (1996). Support groups for bereaved adolescents. In C. A. Corr (Ed.), Handbook of adolescent death and bereavement (pp. 293–311). New York, NY: Springer. Tedeschi, R. G., & Calhoun, L. G. (1993). Using the support group to respond to the isolation of bereavement. Journal of Mental Health Counseling, 15(1), 47–54. Vickio, C. J. (2008). Designing and conducting grief workshops for college students. New Directions for Student Services, 121, 41–50. doi: 10.1002=ss.265

Developing and implementing a bereavement support program for college students.

The death of a loved one can be particularly difficult for college students, as significant losses are not anticipated during this time. Bereavement e...
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