Introduction and Literature Review
The key research issue in the signature assignment case study is the role of trauma-informed care on the posttraumatic growth of bereaved children. The study of this research issue poses tremendous importance. According to McClatchey & Raven (2017), a considerable number of children worldwide experience the demise of a parent. Extensive research indicates that as of 2009, the number of orphaned children globally stood at 153 million. Out of the 153 million orphans, roughly 12% are double orphans, meaning that both parents are dead. In the introduction part of the case study, statistics show that around 1.9 million children in the United States received benefits following the demise of their parents in 2014. Nonetheless, the figure does not comprise children whose parents were undocumented, unemployed, or lacked insurance covers. Therefore, the number of bereaved children may be way greater than what is reported.
The introduction also suggests that although the death of a loved one would deject anyone, children and adolescents experience immense trauma and difficulty. Studies also show that children who have lost a parent may experience many long and short-term effects. Some of the effects of bereavement in children include delays in child development, difficulty in learning institutions, depression, and an upsurge in drug and substance use among bereaved children. Moreover, the children may become deviant and develop a wide range of physical, emotional, and mental health problems.
Outcomes from various studies indicate that positive outcomes can be derived following a traumatic incident. The positive outcome is commonly referred to as posttraumatic growth (PTG). Although posttraumatic growth has been severally studied among adults and youth, very minimal studies have been conducted among bereaved children. This gap is an indication that the research on the impact of trauma-informed care on the posttraumatic growth of children is necessary.
The signature assignment case study by McClatchey and Raven discusses prior research by several researchers. In the “Definitions and Distinctions” section, the article highlights that posttraumatic growth has been investigated in adults on numerous counts. However, little research has been channeled towards understanding PTG among children. Moreover, there is very scanty research on the measurement of posttraumatic growth among youth and the course of growth.
Researchers have given attention to resilience in children following a traumatic event for a long time. It was not until recently that studies began to focus on the impact of trauma-informed care (TIC) in promoting posttraumatic growth. According to previous research, PTG arises from the concept of “cognitive processing.” In this context, cognitive processing refers to retrospecting one’s belief following an unforeseen, traumatic incident. Although posttraumatic growth is almost similar to resilience, it differs in the sense that it addresses positive changes after a period of anguish as opposed to the ability to stay strong in the face of trauma.
Prior research also reveals that PTG is not derived from traumatic incidences. However, the struggle an individual undergoes in the face of trauma. The struggle usually emanates from the traumatic incident, making the affected person question their views before the trauma. The individuals’ world perspectives crumble, and they are forced to view the world differently and adjust their beliefs and aspirations.
The “Definitions and Distinctions” section also states that numerous unpleasant consequences are recorded when disasters strike. Nonetheless, massive research conducted over the last 20 years indicates that disasters can also bring forth positive outcomes. The positive outcomes in the wake of a disaster are associated with PTG. Although the positive changes may manifest in various ways, they are grouped into several categories. These classifications comprise changed life philosophies, a change in oneself, a changed view on the individual’s relationships, and the entrenchment of the person’s spirituality.
Once an individual’s perception of oneself changes, they acquire greater strength and the will to survive and endure. After a re-evaluation of one’s relationships, an individual who has undergone trauma will likely appreciate those close to them more. In addition, the persons are highly likely to become more compassionate and empathetic to others. Recovery from trauma may also prompt individuals to evaluate their value system and priorities, thus making better decisions. Embracing a spiritual life through cognitive change also allows individuals to appreciate their overall existence better.
Nevertheless, several researchers argue that cognitive change alone is unsatisfactory in promoting individual development. Researchers who argue that cognitive change is inadequate also claim that behavioral change is imperative to determine real PTG. Other researchers remain entirely firm on the claim that posttraumatic growth is nothing but an illusion.
In the “Posttraumatic Growth and Posttraumatic Stress” section, the criteria for diagnosing posttraumatic stress disorder (PTSD) are given. One can have experienced PTSD when they witness or get wind of news concerning a traumatizing event on their close friends or family. According to previous research, exposure to horrifying details concerning a traumatic event can predispose an individual to posttraumatic stress disorder.
To be considered to have PTSD, they must exhibit a range of symptoms such as avoidance, intrusion, adverse changes in mood, and a significant change in sensitivity and provocation. The said symptoms should prevail for more than 30 days and bring about significant clinical issues that impair the individual’s everyday social and occupational operations. These symptoms should also be exclusive of those caused by drug abuse or an underlying sickness.
Studies in the past have shown a significant association between symptoms of PTSD and posttraumatic growth. These studies show that posttraumatic stress symptoms may proliferate the PTG process in youths. Another study also found out that posttraumatic stress disorder and posttraumatic growth can co-exist within the same individual at the same time. A high degree of either does not necessarily mean that the other is lower. For instance, one can be having high levels of PTSD and still record impressive posttraumatic growth. Additionally, some researchers claim to have found zero connection between posttraumatic stress disorder and posttraumatic growth.
In the section titled “Posttraumatic Stress Disorder and Grief,” uncomplicated grief is defined as a feeling of sorrow, disinterest in day-to-day operations as well as lack of focus. Grief may also bring about problems relating to sleep and appetite. Some studies reveal that children cope quite well in the face of grief. Other researchers report that an enormous number of children experience posttraumatic stress disorder and signs of complicated grief following the demise of their parents. Research also indicates that orphaned children are prone to posttraumatic stress disorder regardless of whether the passing away of their parents was expected or not. In children who have lost their loved ones, symptoms of PTSD may hinder the grieving process.
In the “PTG among Youth” section, the article says that there has been enormous research on posttraumatic growth in youths who have undergone traumatic events such as terrorist attacks, earthquakes, and hurricanes. However, no substantial literature is available on PTG among youth and children who have lost their loved ones. Studies show that bereaved youth are likely to exhibit PTG in the form of gratitude for life, fostering better relationships, and seeking assistance from older persons.
Previous studies have also addressed the effects of current posttraumatic growth research and attempt to advise professionals on how PTG can be promoted among minors. Nonetheless, researchers argue that it is crucial to understand the variation in the awareness of bereaved children. Practitioners should therefore purpose to provide trauma-informed care to promote posttraumatic growth of youth and children who have lost their loved ones. The use of trauma-focused cognitive behavioral therapy (TF-CBT) has also proven effective in promoting posttraumatic growth in youths.
Under the “Outcome Studies” part, McClatchey and Raven state that only a few studies have looked into the promotion of PTG in minors. Studies in the recent past only provide incomplete information relating to the possibilities of PTG in children following a traumatic situation. The article provides data collected from an outcome study conducted in Norway. The study consisted of a total of 148 youth who had experienced varying traumas. The participants were treated at a psychological health institution using TF-CBT and were checked for posttraumatic stress disorder and posttraumatic growth before and after the session.
Findings from this research indicate that the percentages of PTG proliferated after the treatment period. Even though all participants exhibited signs of PTSD, no significant relationship was found between PTG and PTSD. The article has addressed several other pieces of research, and the results suggest that children and youth in their grieving period should be placed in a healthy environment where they can record positive outcomes.
Primary Purpose of the Study
Based on the introduction and the literature review sections, the principal of the signature assignment case study is to find out the outcomes of trauma-informed care on the posttraumatic growth of bereaved children.
- Can adding trauma-informed care to grief interventions facilitate posttraumatic growth among bereaved youth?
- Does trauma-informed care increase PTG in children?
The dependent variable in the study is posttraumatic growth (PTG). One of the independent variables of the research is trauma-informed care (TIC).
According to the “Participants” section under “Method,” the sample population for the study comprised 105 children and teenagers. The participants’ ages ranged between 6 and 17 years. These participants were at a bereavement healing camp that was meant to take a weekend. Participants had to meet the eligibility requirements of bereavement and be of the ages 6 to 17. A purposive sampling technique was employed to select participants for the non-equivalent comparison group study. This sampling method is suitable as it allowed for the involvement of only children and teenagers who were bereaved.
The study took place within two camp sessions. Information relating to the bereavement camps was made public to counselors at school three months and four months before the first and second sessions, respectively. Once prospective participants had signed up for the camps, their caregivers were contacted using emails and telephone calls. For the first camp, 67 children showed interest in participating. Of these, only 52 received consent from their parents and guardians. During the second session, 69 campers had registered. However, only 54 received their caregiver’s go-ahead. All the candidates who received parental consent took part in the study apart from one who withdrew during the second camp.
About a month following the two camps, 91 out of the 105 participants who had been pre-tested showed up for post-testing. 63% were male in the pre-test, while 47% were female. The study consisted of participants from various ethnic backgrounds, including African Americans, Latinos, Caucasians, Indians, and Pacific Islanders. However, the statistics indicate that there was not enough diversity among the participants. The study also has minimal generalizability as there was no randomization. The number of participants is also too small to represent the entire population of bereaved children and teenagers.
PTG among the participants was measured using the Revised Posttraumatic Growth Inventory for Children (PTGI-C-R). This tool contains a 10-item list used in the assessment of PTG. The inventory assessed five facets of posttraumatic growth. These facets include relationships with other persons, alterations in spirituality, individual strength, gratitude for life, and fresh possibilities. The tool had a scale of four points, with one meaning no changes at all and 4 representing a significant change in the domains. Data was collected by asking ten questions that the participants were required to grade between 1-4 on the PTGI-C-R.
The symptoms for PTSD among the participants were measured using section five of the University of California at Los Angeles (UCLA) Reaction Index for DSM-5. This tool contains 27 items used in the assessment of posttraumatic stress disorder. Participants were required to grade their symptoms on a scale of 1 through 4. On the scale, scores of 3 and 4 prove that one has PTSD. However, an exception is given for items 4, 10, and 26. A score of 2 and above on the exempted items proves posttraumatic stress disorder symptoms.
This study uses a quasi-experimental research design. The research design can produce credible results and meet the objectives of the study. However, the research design used in this study poses a threat to internal validity.
The “Analysis and Results” section indicates that the treatment and comparison teams were similar in terms of gender, age, type of loss, and the form of death. On the other hand, these groups showed differences in the racial groups. For instance, the treatment group had more African-American individuals than the comparison group. Results from the study indicate that children and teenagers who took part in the bereavement camps came out with lower posttraumatic stress disorder levels than those in the comparison teams. The difference, however, was very minimal.
Moreover, children who did not participate in the treatment program showed more significant symptoms of dissociation. Male participants in the treatment group also showed more significant improvement in reducing PTSD compared to the females. Lastly, results from the study showed that there was no considerable difference in PTG resulting from the different types of deaths under study.
In the “Discussion” section, McClatchey and Raven, in their article, conclude that PTG among youth that attended the bereavement camps was higher than in those who did not attend. The authors also acknowledged that the study was very significant in reducing PTSD and proliferation of posttraumatic growth among children and teenagers. However, the study also faced some limitations. The article notes that the research design used may pose a significant threat to the study’s internal validity. Additionally, the research did not have enough diversity and lacked a control group. Another limitation is that the sample size was significantly tiny, and there was no randomization.
Future researchers on this topic will be required to identify the effects of counselor-camper ethnicity on posttraumatic growth results. This information has been acquired from the “Future Research and Practise” part. Moreover, researchers will also need to look into the impact of socioeconomic status on posttraumatic growth. The section also states that social support is essential during the grieving period. However, the topic has not been researched extensively. Therefore, future researchers should aim to examine the impact of social support and general social work practice on PTG.
McClatchey, I. S., & Raven, R. F. (2017). Adding trauma-informed care at a bereavement camp to facilitate posttraumatic growth: A controlled outcome study. Advances in Social Work, 18(1), 349-368.