Pilot Evaluation: Children and Grief Manual for Adolescent Prolonged Grief During COVID-19, the Genocide in Gaza, and Increased Violence in the West Bank.

The study evaluated the efficacy of the Children and Grief Manual for Palestinian adolescents who experienced multiple overlapping losses and prolonged grief because of COVID-19, the genocide in Gaza, and the increased military, and settler violence in the West Bank. One hundred and nineteen adolescents referred to school counselors in the occupied West Bank for prolonged grief received 7 two-hour sessions of the Manual on a weekly basis. A pre-post and 9-month follow-up design utilized measures of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression and assessed program fidelity and a measure of future cost. Interviews were conducted with counselors and adolescents. The study found high levels of program fidelity (8.6/10) leading to significantly reduced PGD (d = 0.449), PTSD (d = 0.729), and depression (d = 0.400) at post-test. Gains were maintained for PTSD (d = 0.407) and PDG (d = 0.137) at follow-up. Counselors reported that the Manual was a healing experience that was highly tolerated by adolescents. For scaling up, the Manual was relatively inexpensive to deliver. In settings of ongoing violence, it is recommended that repetition of the Manual or booster sessions be considered to support the maintenance of gains. A significant limitation of the study was the pre-post-test follow-up design. Future research needs to include pragmatic randomized control trials.