CAG validation study

Validating the Child Attitude to Grief Scale for research and clinical practice with bereaved children and young people.

Short description

The Child Attitude to Grief (CAG) Scale is adapted from the Adult Attitude to Grief Scale (Sim et al 2014). The scale includes nine items/questions which explore how a bereaved child or young person is responding to and coping with their grief.

The CAG scale is currently being used with children aged seven and upwards by a small number of child bereavement and hospice services, including Winston’s Wish. This project will undertake two stages of validation of the measure to help develop and determine its suitability for use in clinical practice and as a research and evaluation tool with bereaved children and young people.

Background

The need for formal assessment and screening practices to determine the need and appropriate support provision is well established in bereavement policy and practice. A wide variety of tools are available to assess grief and bereavement support needs in adults. Child-specific measures are also needed; alongside differences in language abilities, significant life relationships and contexts (e.g. parental, school/education systems), it is recognised that grief reactions also vary across the lifespan, as the meaning of loss can differ based on age and development (Kaplow et al., 2014).

The Child Attitude to Grief (CAG) Scale, is adapted from the Adult Attitude to Grief Scale (Sim et al 2014). Like the original adult version, the scale is based on the Range of Response to Loss model (Machin 2001), which identifies two distinct dimensions of grief: first, a spectrum of instinctive reactions to loss from being  ‘overwhelmed’, a state dominated by emotional/cognitive distress to being ‘controlled’, needing to avoid emotional expression and focus away from the loss;  second, conscious coping reactions where  ‘resilience’ or its absence (vulnerability), indicate the characteristic of effective coping. The scale is currently being used clinically with children aged 7 and upwards, by a small number of child bereavement and hospice services. However, although the measure is considered to be working well as a clinical tool, it has not yet undergone any formal scientific validation. To address this need, this project will carry out two stages of validation of the measure, to help develop and determine its suitability for use in clinical practice, evaluation and as a research tool with bereaved children and young people aged 7-18.

Aims

To refine and evaluate the Child Attitude for Grief Scale to determine its suitability for use in clinical practice, evaluation and as a research tool.

Phase one:
To assess (and if needed improve) the face and content validity of the CAG scale, using stakeholder focus groups and cognitive interviews with service users.

Phase Two:
To field-test the questionnaire with service users to establish its construct validity, structural validity, internal consistency, reliability (test-retest), measurement invariance, measurement error and responsiveness.

Progress

The study began in March 2023. It is anticipated that data collection will begin in October 2023.

References

Sim, J., Machin, L. and Bartlam, B., 2014. Identifying vulnerability in grief: psychometric properties of the Adult Attitude to Grief Scale. Quality of Life Research, 23, pp.1211-1220.

Kaplow JB, Saunders J, Angold A, Costello EJ. Psychiatric symptoms in bereaved versus nonbereaved youth and young adults: a longitudinal epidemiological study. Journal of the American Academy of Child & Adolescent Psychiatry. 2010 Nov 1;49(11):1145-54.

Machin, L. (2001). Exploring a framework for understanding the range of response to loss; a study of clients receiving bereavement counselling. Unpublished PhD thesis: Keele University, UK.