Adolescent Bereavement Initiative in the Free State, South Africa
Condition: Grief; Bereavement
Study type: Interventional

Summary: 
      Coping with Loss is a randomized controlled trial to assess the effectiveness of a
      bereavement intervention targeting female adolescents who have experienced the death of
      someone important in their lives. Adolescents aged 12 and older in the Free State province of
      South Africa will be invited to participate in an 8-session school-based peer support group
      focused on coping with loss. Interventions will be implemented by Social Workers from Child
      Welfare Bloemfontein and Childline Free State (CWBFN & CLFS) that have provided support
      services for orphans and vulnerable children (OVC) in the Free State Province since 2013. The
      study population will be identified through the CWBFN & CLFS intake process and consist of
      bereaved female adolescents from up to 11 participating schools. Eligible adolescents will be
      randomly assigned to receive the intervention in 2015 or wait-listed for enrollment following
      the study period. Survey data will be collected from adolescents and caregivers before and
      two months following the completion of the interventions. Data will be analyzed to assess for
      pre- and post-test differences between the intervention and wait-listed group on key
      psychosocial outcomes, including measures of grief, resilience, mental health, social
      support, academic competence and adolescent-caregiver interactions.
    

Detailed description: 
      The HIV/AIDS epidemic, accidental injuries and violence have gradually increased the
      mortality rate among prime age adults in South Africa since 1997 (Statistics South Africa,
      2006) leading to an increase in the number of children experiencing bereavement. Of the
      approximately four million orphans in South Africa in 2012, over half (62.5%) are due to
      parental death from AIDS (UNICEF, 2013). Studies have found that parental loss in childhood
      and adolescence is associated with a range of immediate and later life outcomes including
      problems at school, depression, criminality, early sexual activity, and unemployment
      (Aynsley-Green, 2012). However, support counselling for bereaved children and adolescents is
      virtually nonexistent in South Africa (Collingwood, 2014) and children are often not
      encouraged to express grief or participate in mourning rituals for the deceased. A randomized
      controlled trial of AIDS orphans in Uganda found that school-based peer support groups
      reduced the symptoms of anxiety, depression and anger compared to a control group that did
      not participate in the peer support groups (Kumakech, 2009). This base of evidence
      demonstrates both the unmet need and potential impact of a bereavement initiative that will
      be offered by CWBFN & CLFS in Free State. This research will contribute to the evidence base
      for effective programming for bereaved adolescents in South Africa as well as other high HIV
      prevalence populations.

      The aim of this study is to assess the effectiveness of time-limited adolescent grief
      counseling peer groups in improving the psychosocial wellbeing of bereaved female
      adolescents. Results from the study will be used to develop evidence-based youth bereavement
      counselling programs to be implemented in additional areas of South Africa. The results will
      be presented to South African OVC social service organizations as well as submitted to
      peer-reviewed scientific journals for wider dissemination.

      (Note that the original study design included a family component/sessions for caregivers that
      was not able to be realized by the program implementers)
    

Intervention name(s): Abangane Support Group
Intervention type(s): Behavioral
Intervention description(s): The Abangane support group program consists of 8 sessions for bereaved adolescents with standardized activities and discussion content based the Khululeka Grief Support Program in Cape Town, South Africa. The materials include a resource book that provides training and referral agencies for grief group facilitators as well as exercises and creative activities designed to stimulate group discussions that will help adolescents to deal with loss and grief.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: orphans and vulnerable children; South Africa; peer support group