ultiple changes associated with parental death, a stable environment is very important for positive adaptation (Haine et al., 2008). Implementing consistent discipline and routines, facilitating discussions of feelings, and appropriately interpreting acting-out behaviors may be beneficial to bereaved children's adjustment (Hope & Hodge, 2006). An environment with a predictable routine, clear and specific rules and expectations, and consistent follow-through has been associated with fewer mental health problems among parentally bereaved children (Worden, 1 996). Similarly, ensuring that a child's basic needs are met, helping children identify personal strengths, and promoting strong connections and social support for bereaved children are important.
Clearly, there are a number of factors that may influence the adjustment of parentally bereaved children. As a result, when working with these children and their families, counselors should consider influences from various levels (individual, family, environmental) in each child's life.
TREATMENT FOR PARENTALLY BEREAVED CHILDREN
Although studies of the use of empirically supported interventions with this population are few, some clinically relevant information comes from projects like the Family Bereavement Program (FBP; Sandler et al., 2003) that reiterate the importance of increasing children's understanding of their grief experiences.
Although researchers have examined intervention programs for bereaved adults, little is known about effective treatments for facilitating the grieving process in children, particularly children experiencing complicated or traumatic grief (Boelen et al, 2006). More research is necessary for gaining a better understanding of the consequences and outcomes associated with childhood grief, as well as the components of effective treatment (Thompson et al., 1998).
Because "grief refers to the child's personal experience of the thoughts, emotions, and behaviors associated with the loss" (Lampton & Cremeans, 2002, p. 468), a cognitive-behavioral approach might be most effective. According to Stubenbort and Cohen (2006), treating children with complicated grief requires treatment of both trauma and grief symptoms. Similarly, successful outcomes are associated with the inclusion of surviving family members in the treatment process. Trauma-focused cognitive-behavioral therapy (TF-CBT) is a manualized treatment approach for children and their parents drawn from extensive work with trauma survivors. Cognitive-behavioral techniques have been used successfully to treat sexually abused children (Cohen & Mannarino, 1996; Cohen et al., 2000) and bereaved adults and children after an airline disaster (Stubenbort, Donnelly, & Cohen, 2001).
Dunning (2006) suggests that promoting adjustment of parentally bereaved children involves interventions that frame the concept of death cognitively, affectively, and behaviorally. The cognitive frame emphasizes the sharing of accurate and factual information about the death to avoid "magical thinking" and unnecessary responsibility-taking by the child. Information should be presented to children in language appropriate to their cognitive development. The affective frame involves talking with bereaved children about the negative feelings associated with the loss and helping them identify and label their feelings appropriately. Finally, the behavioral frame involves such topics as children understanding their own behaviors and the behaviors of adults. For example, witnessing the surviving parent crying or expressing anger or frustration can be a source of distress and misunderstanding for children. Counselors will want to communicate openly with bereaved children about challenges they may experience in school and other social milieu. Counselors can also develop a plan with children on how much to tell, who to tell, and how to answer questions about their loss. Such planning may help alleviate worries and uncertainty for grieving children as they adjust to their loss.
Schuurman (2003) highlights practical suggestions for children 