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SIG Spotlight: The Traumatic Loss and Grief SIG – Christopher M. Layne, PhD, and Julie B. Kaplow, PhD, ABPP

by | Sep 24, 2020 | Assessment and Psychometrics, SIG Spotlight, StressPoints | 0 comments

Widespread unmet needs arising from deaths due to the opioid, suicide, homicide, AIDS, COVID-19 and other epidemics are being met by an opportunity to make major strides in raising the standard of bereavement care worldwide. For the past three years, Drs. Robert Pynoos and the Traumatic Loss and Grief SIG Co-Chairs, Drs. Christopher Layne and Julie Kaplow, have been working with the American Psychiatric Association (APA) to formulate developmentally informed criteria for a new grief disorder in DSM-5-TR. This work is part of a broader effort: Two new grief disorders (both termed Prolonged Grief Disorder) will likely be introduced within the next two years. The first will come in DSM-5-TR (on track for formal adoption by winter 2020) and the second in ICD-11 (scheduled for release in January 2022).

This collaboration culminated in an invitation by the APA’s DSM Steering Committee to present at a Workshop on Developing Criteria for a Disorder of Pathological Grieving, which was held in June 2019. Aims of the workshop included considering the perspectives and data from major research groups, exploring the extent to which proposed diagnostic criteria for prolonged grief disorder meet criteria for a mental disorder, and inform the deliberations of a Criteria Development Panel charged with proposing the official criteria set for DSM-5-TR.

Bob Pynoos and Chris Layne personally attended the APA Workshop—Bob in the capacity of an advisor and Chris as one of three research-scientist presenters. Dr. Julie Kaplow and her team from the Trauma and Grief Center contributed data and conducted relevant analyses to inform the presentation. Drawing from multiple sources, including a New York Life Foundation-funded practice research network (PIs: Kaplow and Layne), the Trauma and Grief Center at Baylor College of Medicine, post-September 11th New York City, and post-war Bosnia, the presentation (Layne, Kaplow, Oosterhoff, & Hill, 2019) covered multiple topics. These included:

  1. Providing an overview of multidimensional grief theory (Kaplow, Layne, Saltzman, Cozza, & Pynoos, 2013; Layne, Kaplow, Oosterhooff, Hill, & Pynoos, 2017) as a lens through which to conceptualize grief as a multidimensional construct, including adaptive versus maladaptive grief reactions.
  2. Reviewing evidence regarding persistent complex bereavement disorder, a provisional disorder listed in DSM-5, and its relevance to children and adolescents (Kaplow, Layne, Pynoos, Cohen, & Lieberman, 2012).
  3. Offering empirical evidence and developmental recommendations for the newly proposed Prolonged Grief Disorder (Kaplow, Layne, Oosterhoff et al., 2018).

A lively discussion between presenters, panelists, and advisors ensued. In the months following, the APA Panel posted proposed diagnostic criteria for prolonged grief disorder in an invited public commentary period that ran between April and May 2020.

As part of ongoing efforts to educate and engage care providers and child advocates in this public commentary, Dr. Layne led a webinar for the Trauma and Loss SIG and other concerned groups in March 2020. Entitled “DSM-5-TR Prolonged Grief Disorder: Become an Informed Consumer and Advocate,” the webinar was sponsored by the National Child Traumatic Stress Network (NCTSN). Dr. Layne described proposed diagnostic criteria for prolonged grief disorder, described a timeline for the public commentary and the APA’s subsequent deliberations, reviewed selected evidence, and reviewed the team’s recommendations for modifying the proposed criteria to enhance their developmental appropriateness. A recording of the webinar, the team’s developmental recommendations, initial 2019 presentation, and final 2020 summary report, can all be accessed through the NCTSN Learning Center. The post-public commentary diagnostic criteria for prolonged grief disorder will be reviewed by the APA Board of Trustees and the APA Assembly, and may be formally adopted as early as winter 2020. ICD-11 criteria for prolonged grief disorder have already been adopted, and efforts to develop validated scales and structured clinical interviews are currently underway (O’Connor et al., 2020). The extent to which the two grief disorder (ICD-11 and DSM-5-TR) criteria sets overlap remains to be seen, although the ICD-11 version has given strong emphasis to clinical utility (Killikelly & Maercker, 2017).

During the last three years, other efforts to raise the standard of care by the SIG leadership include publications on conceptualizing and treating traumatic bereavement (Layne et al., 2017); evidence-based assessment of traumatized youth with bereavement histories (Layne, Kaplow, & Youngstrom, 2017); treatment of persistent complex bereavement disorder (Kaplow, Layne, & Pynoos, 2019); evidence-based assessment of bereaved youth (Layne & Kaplow, 2020); treatment of grieving youth using multidimensional grief theory (Kaplow, Layne, Pynoos, & Saltzman, under contract; Hill, Oosterhoff et al., 2019); identifying links between grief and suicide ideation (Hill, Kaplow et al., 2019), a method for estimating sibling bereavement rates (Hulsey et al., 2018); and modularized intervention with adolescents exposed to trauma, bereavement and traumatic bereavement (Saltzman et al., 2017). Dr. Layne has led the ISTSS SIG meetings during this same period, facilitating discussions on prolonged grief disorders in ICD-11 and DSM-TR; strategies for recruiting students, researchers and clinicians into the bereavement field; and the need for assessment tools and research studies that differentiate between trauma and bereavement and between PTSD and grief. SIG members have also explored opportunities to collaborate on various studies, including those comparing grief across groups (e.g., age, gender, culture, race, relationship to deceased, manner of death).

The Traumatic Loss and Grief SIG has also applied its expertise to addressing the needs of those bereaved by COVID-19 and ongoing opioid, suicide and murder epidemics. Recent efforts include webinars for mental health professionals and primary care providers who work with bereaved youth and families (Layne, 2020; see also Promoting healthy grief), and for behavioral health professionals who work with bereaved military families. We have also conducted webinars and live discussions focusing on children’s grief reactions and how to support grieving youth especially in the context of the pandemic. In collaboration with the Bereavement Workgroup of the National Child Traumatic Stress Network, as well as the New York Life Foundation, Dr. Kaplow also produced a series of handouts for parents called The Power of Parenting that focus on ways in which caregivers can support children in anticipation of an impending death as well as after a death.

How to Join this SIG

If you are interested in joining the Traumatic Loss and Grief SIG, please contact Chris Layne or Julie Kaplow. Citations for all published articles authored by us can be found at our ResearchGate accounts: https://www.researchgate.net/profile/Christopher_Layne and https://www.researchgate.net/profile/Julie_Kaplow. 

About the Co-Chairs

Julie Kaplow, PhD, ABPP, is a licensed clinical psychologist, board certified in clinical child and adolescent psychology. Dr. Kaplow is also the Founder and Executive Director of the Trauma and Grief (TAG) Center at The Hackett Center for Mental Health in Houston, Texas. In this role, she oversees the development, evaluation and dissemination of trauma- and bereavement-informed “best practices” to community providers nationwide and assists in translating these practices into policy.
 
Dr. Christopher Layne, a licensed clinical psychologist, is Program Director of Education in Evidence-Based Practice at the UCLA/Duke University National Center for Child Traumatic Stress, where he leads the development of the Core Curriculum on Childhood Trauma. Dr. Layne is also a Research Psychologist in the Department of Psychiatry at UCLA. His professional interests include traumatic stress and bereavement, developmental psychopathology, resilience, evidence-based practice, evidence-based assessment, theory building, research methods, professional education, and trauma- and bereavement-focused intervention with young people.

References

  1. Hulsey, E., Hill, R. M., Kaplow, J. B., Layne, C. M., & Gaffney, D. (2018). Estimating the incidence rate of sibling bereavement among children and adolescents across the United States: A proposed method. Death Studies.  DOI: 10.1080/07481187.2018.1541946
  2. Hill, R. M., Kaplow, J. B., Oosterhoff, B., & Layne, C. M. (2019). Understanding grief reactions, thwarted belongingness, and suicide ideation in bereaved adolescents: Toward a unifying theory. Journal of Clinical Psychology. Published online at https://doi.org/10.1002/jclp.22731
  3. Hill, R., Oosterhoff, B., Layne, C. M., Rooney, E., Yudovich, S. Pynoos, R. S., & Kaplow, J. (in press). Multidimensional Grief Therapy: Pilot open trial of a novel intervention for bereaved children and adolescents. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-019-01481-x
  4. Kaplow, J.B. (2020, March). Discussing death with children: An interview with Dr. Julie Kaplow. Invited webinar hosted by Child Trends, National Science Foundation. Available at https://www.youtube.com/watch?v=L4l0cqS5Pls.
  5. Kaplow, J.B., Layne, C. M., Oosterhoff, B. Goldenthal, H., Howell, K.H., Wamser-Nanney, R., Burnside, A., Calhoun, K., Marbury, D., Johnson-Hughes, L., Kiesel, M., Staine, M.B., Mankin, M., Porter-Howard, L., & Pynoos, R.S. (2018). Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A developmentally-informed assessment tool for bereaved youth. Journal of Traumatic Stress, 31, 244–254.
  6. Kaplow, J.B., Layne, C. M., & Pynoos, R.S. (2019). Diagnosis and treatment of Persistent Complex Bereavement Disorder in children and adolescents. In M. Prinstein, E. Youngstrom, E. Mash, & R. Barkley (Eds.), Treatment of childhood disorders, 4th Edition (pp. 560-590). New York: Guilford.
  7. Kaplow, J.B., Layne, C. M., Pynoos, R.S., Cohen, J., & Lieberman, A. (2012). DSM-V diagnostic criteria for bereavement-related disorders in children and adolescents: Developmental considerations. Psychiatry, 75, 243-266. DOI:http://dx.doi.org/10.1521/psyc.2012.75.3.243
  8. Kaplow, J. B., Layne, C. M., Pynoos, W. S., & Saltzman, W. R. (manual in preparation). Multidimensional Grief Therapy: A Flexible Approach to Assessing and Supporting Bereaved Youth. Under contract with Cambridge University Press.
  9. Kaplow, J.B., Layne, C. M., Saltzman, W.R., Cozza, S.J., & Pynoos, R.S. (2013). Using multidimensional grief theory to explore effects of deployment, reintegration, and death on military youth and families. Clinical Child and Family Psychology Review, 16, 322–340. DOI:10.1007/s10567-013-0143-1.
  10. Killikelly, C., & Maercker, A. (2018). Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European journal of psychotraumatology, 8(Suppl 6), 1476441. https://doi.org/10.1080/20008198.2018.1476441
  11. Koncikowski, J., Hill, J., Kaplow, J., Sandler, I., CrossBear, S., LeGore, S., Gardner, S., Lanni, D., Foreman, C., & Harrington-Lamorie, J. (2020). The power of parenting during the Covid-19 pandemic: Addressing fears and feelings from prior losses. Educational pamphlet, New York Life Foundation, New York, NY.
  12. Koncikowski, J., Hill, J., Kaplow, J., Sandler, I., CrossBear, S., LeGore, S., Gardner, S., Lanni, D., Foreman, C., & Harrington-Lamorie, J. (2020). The power of parenting during the Covid-19 pandemic: Helping children cope with the impending death of a loved one. Educational pamphlet, New York Life Foundation, New York, NY.
  13. Koncikowski, J., Hill, J., Kaplow, J., Sandler, I., CrossBear, S., LeGore, S., Gardner, S., Lanni, D., Foreman, C., & Harrington-Lamorie, J. (2020). The power of parenting during the Covid-19 pandemic: Mourning the death of a loved one. Educational pamphlet, New York Life Foundation, New York, NY.
  14. Layne, C. M. (2020, March 25). Developmental Recommendations and Implications for a Prolonged Grief Disorder (PGD) in DSM-5-TR: Become an Informed Consumer and Advocate. [Webinar] Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress. https://www.nctsn.org/treatments-and-practices/dsm-5-tr-prolonged-grief-disorder-informed-consumer-and-advocate.
  15. Layne, C. M. (2020, August 10). Evidence-Based Assessment of Bereavement and Grief in the Era of COVID-19. 1-hour invited webinar delivered to mental health and medical professionals. Available at https://vimeo.com/447198318. 
  16. Layne, C. M., & Kaplow, J. B. (2020). Assessing bereavement and grief disorders. In E. A. Youngstrom, M. J. Prinstein, E. J. Mash, & R. A. Barkley (Eds.), Assessment of Disorders in Childhood and Adolescence (5th ed., pp. 471-508). New York: Guilford.
  17. Layne, C. M., Kaplow, J., Netland, M., Steinberg, A., & Pynoos, R. (2014, November 7). The Differential Validity Matrix: An Innovative Tool for “Contextualized” Test Construction and Theory Building. In C.M. Layne (Chair), Improving Methods for Unpacking the Ecologies of Trauma and Loss: Implications for Two New DSM-5 Disorders. Symposium presented at the 30th Annual Meeting of the International Society for Traumatic Stress Studies, Miami, FL.
  18. Layne, C. M., Kaplow, J. B., Oosterhoff, B., & Hill, R. (2019, June 3). Developmental Perspectives on DSM-5-TR Prolonged Grief Disorder Criteria: Proposals for Improvement. Invited presentation at the Workshop on Developing Criteria for a Disorder of Pathological Grieving for DSM 5-TR. Hosted by the American Psychiatric Association, New York City (Paul Applebaum, M.D., Chair).
  19. Layne, C. M., Kaplow, J.B., Oosterhoff, B., Hill, R., & Pynoos, R.S. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7, 220-239.
  20. Layne, C. M., Oosterhoff, B., Pynoos, R. S., & Kaplow, J. B. (4 February 2020). Developmental Analysis of Draft DSM 5-TR Criteria for Prolonged Grief Disorder: Report from the Child and Adolescent Bereavement Subgroup. Report submitted to the Panel on Developing Criteria for a Disorder of Pathological Grieving for DSM 5-TR (P. Applebaum, Chair). American Psychiatric Association.
  21. Layne, C. M., Kaplow, J. B., & Youngstrom, E. A. (2017). Applying evidence-based assessment to childhood trauma and bereavement: Concepts, principles, and practices. In M. A. Landholt, M. Cloitre, & U. Schnyder (Eds). Evidence Based Treatments for Trauma-Related Disorders in Children and Adolescents (pp. 67-96). Cham, Switzerland: Springer International Publishing AG.
  22. Melvin, M., Kaplow, J., & Barber, L. (2020, September). How to cope with grief during the COVID-19 pandemic. Invited webinar hosted by Let’s Talk Facebook Live Discussion Series, Meadows Mental Health Policy Institute. Available at https://www.facebook.com/OkaytoSay/videos/3212513122197577.
  23. O-Conner, M., Larsen, L., Joensen, B. V., Boelen, P. A., Maccallum, F., Komischke-Konnerup, K., & Bryant, R. A. (28 May 2020). Valid ICD-11 PGD Scales and Structured Clinical Interviews Needed. Frontiers in Psychology, Opinion. Accessed 17 September 2020 at https://doi.org/10.3389/fpsyg.2020.01120.   
  24. Saltzman, W. R., Layne, C. M., Pynoos, R. S., Olafson, E., Kaplow, J. B., & Boat, B. (2017). Trauma and Grief Component Therapy for Adolescents: A Modular Approach to Treating Traumatized and Bereaved Youth. Cambridge University Press.