As part of its vision to fund great science and connect great researchers, MICHR is supporting a study helping Detroit-area children who are in need of mental health services as a result of trauma and grief. The study, “Integrating Evidence-Based Assessment, Training, and Treatment of Childhood Grief and Trauma,” is led by Julie Kaplow, PhD, Assistant Professor and Director of the Trauma and Grief Center for Youth in the Department of Psychiatry at the U-M Health System. Karen Calhoun, a clinical research associate in MICHR’s community engagement program and senior health officer with City Connect Detroit, is co-facilitating the study with Kaplow.

There is growing evidence that youth who have lost a loved one are at significantly higher risk for a range of mental and behavioral health problems, including depressive symptoms, maladaptive grief reactions, poor school performance, and police involvement. Improving care for traumatized and grieving youth requires the thorough integration of evidence-based assessment, treatment, training, and dissemination of best practices. However, in order to effectively treat trauma and maladaptive grief, assessment tools must be designed for the specific populations in which they will be used. Most measures of trauma and grief have not been validated among underserved minority youth. As a result of this new study, school- and community-based mental health professionals in the Detroit area and beyond will soon have a new tool to better assess and eventually treat children who have experienced significant traumas and losses.

“We know anecdotally that grief has a significant effect on school behavior, but this has never been systematically studied,” says Kaplow. “Beyond post-traumatic stress responses, many traumatized and grieving children experience separation distress and identity distress, making it hard to focus in school.” Of the Detroit youth assessed so far, 86% had experienced at least two traumatic events, such as physical abuse or witnessing violence, and 100% had experienced a significant loss such as a parent, sibling, or close friend. “When you’ve experienced multiple losses at such a young age, kids begin to feel like, ‘I’m not going to live that long anyway, so why should I try?’” said Kaplow.

“We are on the tipping point of some innovative approaches to better assess mental health issues in children,” says Calhoun. “Grief is profound in these children who are surrounded by so much death and loss and we’re beginning to learn about the ways in which grief affects children differently than adults.”

Kaplow and Calhoun were brought together by Michelle Riba, MD, U-M’s associate chair for integrated medicine and psychiatric services and former MICHR associate director of mental health. “I realized Julie was reaching out to community partners through her Trauma and Grief Center for Youth, and Karen was working with school-based and school-linked health centers in Detroit without a U-M academic partner, but they had a shared interest in helping Detroit youth, so I made sure they met,” said Riba. “We were also able to connect them with some funding for their research from MICHR.”

“MICHR is proud to sponsor this partnership between the university and Detroit-based health centers that is destined to have a significant impact on the youth of Detroit,” says Tom Shanley, MD, director, MICHR and associate dean, clinical and translational research. “This effort is an exemplar of what MICHR aims to achieve in catalyzing effective, bidirectional relationships between university study teams and community-based programs in order to address significant health challenges. Fostering such community-based research efforts, and particularly when directed towards a major child health target, is ideally aligned with the charge to MICHR by the National Center for Advancing Translational Science to foster community engagement and child health research.”

The prevalence of loss-related traumatic events in these children was profound. The new trauma and grief measures in this study are being developed and validated with youth in Detroit, which is a big change – one of the primary measures used to assess grief in kids prior to this study was originally designed to evaluate grief reactions in elderly Caucasian widows.

Next Steps
As the study continues, next steps include sharing the results of the needs assessment with community partners, continuing to validate and refine the assessment measures, and continuing to train community mental health professionals and partners in the administration of the measures, including public schools in the Detroit area, school-based and community linked health centers run by Henry Ford and St. John-Providence Health Systems, Starfish Family Services, Arab Community Center for Economic and Social Services (ACCESS )and American Indian Health and Family Services (AIHFS). Following the training in the use of the assessment measures, these organizations will be well positioned to receive training in an assessment-driven, evidence-based treatment called Trauma and Grief Component Therapy (of which Dr. Kaplow is a co-author). With additional funding, the training has tremendous potential to expand state-wide and beyond, so that organizations are self-sustaining in conducting their own assessments and using these culturally-appropriate measures to inform the treatment of their community’s youth.

Kaplow and her colleagues also see this work as an important opportunity to learn more about the potential utility or limitations of the newly proposed Persistent Complex Bereavement Disorder (PCBD) that is now included in the appendix of the American Psychiatric Association’s DSM-5, as the criteria for this disorder were primarily drawn from the adult literature and have not yet been examined in minority youth.

A U-M presidential scholar is now working with Kaplow to take the exact model used in Metropolitan Detroit and transport it to Uganda, using the same measures and validation techniques with their youth, who are also experiencing significant levels of trauma and loss but under very different circumstances, including war, mudslides, and AIDS.