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  1. 1. April 2012 Teaching ThanatologyNational Students of AMF: Peer Support and Service as TherapeuticSupports Among Grieving College Students By David Fajgenbaum, MSc questions: What do your parents do? Where’s your mom? But above About one in four college students has expe- all those, I remember the day that Students of AMF became a reality. rienced the death of a family member or close Through the AMF Support Group, I have formed lifelong friend- friend within the past year (Balk, Walker, & Baker, ships with the most incredible people. It is so powerful to have a group 2010). Several factors unique to the college age of other students that understand what I’m going through. They un- and environment can make grief during college derstand those days where everything you see reminds you of your particularly difficult to encounter with resilience. loved one, they understand how hard holidays can be, and they under- These factors include geographic distance from stand those times when you really just need a hug. Students of AMFhome and usual support systems, academic pressures, inadequate has been there for all those moments, and for that, I am so grateful. –peer support and empathy, and limited resources for grief support Kristen graduated from the University of North Carolina in 2011 and ison many college campuses. Thus, grieving college students are at currently a first-year MSW student.greater risk than their peers for a host of physical, academic, social, Service as a mode of supportdevelopmental and emotional issues (Balk, 2008; Servaty-Seib, 2006). Campus Chapter Service Groups encourage chapter members toMoreover, grieving students commonly report feeling alone, help- channel their grief towards championing causes that have impactedless, unsupported, and like no one “gets it” (Fajgenbaum, Chesson, & their own or their peers’ lives. The Service Group provides a tangi-Lanzi, 2012). Despite the need and calls in the literature for improved ble and therapeutic benefit for the bereaved, a positive impact on theuniversity support efforts (Balk, 2001; Wrenn, 1999), few targeted, sup- community at large, and an opportunity for friends of the bereavedportive interventions existed on college campuses before 2005. to show their support. Abundant anecdotal evidence suggest that stu- National Students of AMF dents, especially males, who may shy away from support groups and Following my mother’s illness with cancer and death in 2004, I professional counseling, have found participation in NSAMF serviceworked with other grieving college students and administrators to activities to be a significantly therapeutic and often preferable outletfound the Students of AMF Support Network at Georgetown Univer- (Fajgenbaum, et al., 2012).sity. The acronym “AMF” stands for “Ailing Mothers & Fathers,” but Kelly Hudson, a sophomore at Central Michigan Uni-the student organization is open to all college students grieving the versity, was overwhelmed with distress when her bestillness or death of a family member or friend. “AMF” are also the ini- friend died and her mother was diagnosed with braintials of my mother, Anne Marie Fajgenbaum. AMF made an immediate cancer two weeks afterwards. Six months later, Kellyimpact on Georgetown’s campus, and students from other campuses started a chapter of Students of AMF at Central Michi-requested information about starting up groups using our blueprint. gan. Wanting to do her part to fight back against cancer,In 2006, Ben Chesson (the founder of the University of North Carolina she decided to make their first project a “Give a Spit aboutchapter) and I, both juniors in college, created the National Stu- Cancer” drive. She enlisted fellow grieving and non-griev-dents of AMF Support Network (NSAMF). Today, NSAMF connects, ing students to register students for the bone marrowempowers, and supports hundreds of grieving college students nation- registry by swabbing their mouths. Kelly shared, “it is sowide through NSAMF Campus Chapters. rewarding and feels so good to be able to channel my grief Targeted grief support towards something that is helping my peers on campus NSAMF Campus Chapters are student-led, faculty/staff advised, and and a service project that may save someone else’s life.”university-sponsored student organizations. Each chapter includes a The University of Pennsylvania chapter also organized apeer-led, open-discussion grief support group, service group, and fac- “Give a Spit about Cancer” in Fall 2011 and the two chap-ulty mentoring programs. The Support Group provides a safe and ters combined to register over 400 college students.uplifting environment for bereaved students to share their feelings Interactions among chapters, staff, and the counseling centerand experiences. Several goals are typically achieved during meetings: Lastly, Campus Chapters offer opportunities for faculty mentoring,students feel less alone; they support one another and in doing so help work extensively with campus resources, and promote campus re-themselves; and a rare opportunity for discussion about grief is of- sources with the “student voice.” Chapters refer students reciprocallyfered (Fajgenbaum, et. al., 2012). to counseling services, campus ministry, residential life, and faculty/ I was 16 years old when my mother died. I was incredibly fortunate staff. The most successful chapters are closely linked with the coun-to have the unwavering support of my wonderful friends and fam- seling center, campus faculty/staff, and a dedicated faculty advisor.ily. But, when I went from a small high school where everyone knew Likewise, campus grief support resources, such as campus ministryabout my Mom’s death, to a huge university where nobody knew, I felt and local bereavement resources, have seen an increase in studentcompletely alone. I remember the feelings on move-in day as all the participation on campuses with Students of AMF chapters.other moms helped their kids move into the dorms. I remember the 24 Continued on Page 25Volume 38, No. 2 • April 2012
  2. 2. Teaching ThanatologyNational Students of AMF: Peer Support and Service as Therapeutic Supports AmongGrieving College StudentsContinued from Page 24 Dr. Illene Cupit, a professor of human development at students for grieving college students. NSAMF has also benefited from the University of Wisconsin at Green Bay (UWGB) and the expertise of nonprofit leaders, professional staff, college mental First Vice President of ADEC, decided in 2008 that she health professionals, and bereavement experts, like Dr. Cupit. Unlike wanted to help to bring a chapter of Students of AMF generalized counseling services, NSAMF outlets are targeted to the to UWGB. Illene encouraged one of her students, Kiri specific population in need. Furthermore, NSAMF provides an array Thompson (now a National Students of AMF volunteer of supportive opportunities, since many college students may be re- National Chapter Coordinator), to start a chapter at luctant to participate in support groups or counseling and still others UWGB. Dr. Cupit has served as the faculty advisor for the may benefit from more than one resource. Furthermore, chapter lead- last three years. Under her leadership, chapter members ers make meaning and find benefits through channeling their grief have participated in meaningful support-group meet- towards helping other students. While researchers in other fields have ings, volunteered at Camp Lloyd (a summer camp she studied the direct personal benefit of helping others through service founded for bereaved children), participated in various (Piliavin, 2003), this has not been extensively investigated in thanatol- disease research fundraisers, and created the universi- ogy and serves as an exciting new avenue within the field. ty’s Campus Memorial Garden in honor of deceased loved Current activities and future directions ones of students, faculty and staff at UWGB. Current NSAMF activities include growing existing Campus Chap- National Programming ters, marketing to new campuses, developing partnerships with NSAMF provides an array of resources to facilitate the creation national advocacy organizations and potential funding sources, host-of Campus Chapters that empower students and faculty, like Kris- ing the annual National Conference on College Student Grief in Augustten, Kelly, Kiri and Dr. Cupit. The online Chapter Toolkit and Support 2012, creating an Alumni Network, and leading National College Stu-Group Leader guide offer best practices regarding how to receive offi- dent Grief Awareness week in April 2012. Future activities includecial university recognition, lead Support Group meetings and Service hiring additional staff to lead chapter development, expanding cam-events, and promote the chapter. Volunteer Chapter Coordinators pus grief workshops for students and faculty members, developingand monthly conference calls guide Chapter Leaders through the pro- innovative methods to use social media and technology to connectcess of growing their chapter. NSAMF offers financial assistance for and support grieving college students, and disbursing student tuitionchapter costs, such as T-shirts/promotional items, refreshments at scholarships and research grants to evaluate program effectiveness.meetings and events, printing/copying costs, and expenses for chapter I encourage you, as thanatologists and/or university members, toleaders to attend the annual National Conference on College Student champion the needs of grieving college students. Please consider theGrief. Periodically, the Board of Mental Health Professionals, which is following suggestions and visit for more in-composed of college mental health and bereavement experts, is con- formation.sulted for advice related to a specific chapter or member. Student-level NSAMF also raises awareness through National College Stu- • Educate bereaved students about the unique challenges thatdent Grief Awareness Week, provides grief support and information they may face and the grief resources that are available (e.g.,through, and hosts the annual National Con- Campus Ministry, Residential Life);ference on College Student Grief. The Conference, held inaugurally • Encourage grieving college students, particularly males, to vol-in 2008, provides a national forum for student leaders, grieving col- unteer for service activities, such as a local cancer walk, inlege students, university faculty and college mental health leaders to memory or honor of a loved one;discuss issues and future directions for college student grief support. • Share information about NSAMF with students and encourage Achievements them to consider starting a Campus Chapter; Over the last six years, NSAMF has worked with students from Campus-levelover 160 colleges and universities to start up Campus Chapters, de- • Determine if there is an identified contact or location on cam-veloped 42 officially recognized Campus Chapters, supported over pus where bereaved students already can go to seek support,1,500 grieving college students, and received hundreds of testimonials such as the counseling center, Dean of Students’ office, campusof improved well-being, retention in school, and sense of community ministry, or NSAMF chapter;from its members. Our accomplishments have been featured in USA • Facilitate the creation or growth of a NSAMF Campus ChapterToday, Reader’s Digest, and the Today Show. Recently, Eli Lilly se- at your university as a faculty advisor or informal advisor (con-lected NSAMF as the recipient of the 2012 Welcome Back Award in tact us, and we will guide you step by step);Community Service for our work to improve the lives of those suffer- • Consider developing an annual memorial service or memorialing from depression. garden on your campus; Innovative approach to college student grief support NSAMF is the first initiative of its kind: created by grieving college Continued on Page 28 Volume 38, No. 2 • April 2012
  3. 3. April 2012 Clinical Issues in ThanatologyTreatment for Adolescents After the Violent Death of Someone Close By Alison Salloum, PhD about their perceived role in the violent death as well as the roles of oth- ers. Questions of “why did it happen” may begin to shatter worldviews of After the violent death of someone close, many safety and personal views of positive visions for the future. When work- youth are left with horrific violent dying imagery that ing with youth bereaved by a violent death, assess the youth’s perspective replays constantly in their mind. They may struggle about their current life and future. Some questions to ask include: to shut out any person, place or thing that reminds • Who does the youth feel most connected to? them of the violent death. Even if the youth did not • What does the youth enjoy doing, and do they have the opportunity witness the event, violent death narratives are often to engage in these healthy activities?filled with gruesome images of the dying that keep the youth’s mind and • What is important to the youth (i.e. what has meaning and pur-body highly distressed. Practitioners need to use assessment tools to iden- pose)?tify highly distressed youth, be informed about ways to help youth with • What do they see themselves doing in the future?their questions of why and justice, actively work to help increase cop- • Youth who have positive connections to others, are engaged ining capacity, and, when needed, provide empirically supported grief and meaningful activities, and have a positive vision for the future willtrauma treatment. be better able to cope with violent death than youth who are dis- Assessment Measures connected from others, view everything as meaningless, and do Community practitioners working with adolescents after violent death not have a positive vision for the future. For those disconnectedare encouraged to use assessment measures to plan and monitor treat- youth, enroll the help of others.ment. Some practitioners may argue that when working with bereaved • Are there cousins, uncles, aunts, friends who could spend moreyouth, assessment measures are not necessary. However, research sug- time with the youth?gests that, after violent death, some youth may experience posttraumatic • Are there activities that the youth once enjoyed doing that he orstress (Nader, Pynoos, Fairbanks, & Frederick, 1990; Zinzow, Rheingold, she could engage in again or other activities that may be of inter-Byczkiewicz, Saunders, & Kilpatrick, 2011), depression, and functional est?impairment (Melhem, Porta, Shamseddeen, Payne, & Brent, 2011). It is • Are there mentors or experiences that could help the youth envi-imperative to be aware of comorbidity as these conditions can further sion themselves as having a more positive future?complicate the bereavement process. It is also important to assess for • What would the person who died say to the youth about what theirother losses and traumatic events. Many standardized measures include a hopes and dreams would be?list of potentially traumatic events, and having the youth review the list will Young people need to be provided with information that offers a fullerhelp the practitioner be better informed about past and current losses and understanding of related facts about the death, although the reality is thattraumatic events that may complicate the bereavement process. for some deaths, the “why” cannot be fully known. Nonetheless, many When administering assessment measures, inform the youth that there youth will begin to create a story about why the death occurred and mayis a range of symptoms and that other youth who have had someone need more information as they struggle with difficult questions. If the deathclose die have experienced these reactions. Assessment instruments can was by suicide, it may be helpful to have a discussion aided by a fact sheetbe used to normalize and educate the youth about possible reactions about suicide, then discuss perceptions or conclusions that the youth mayafter a violent death. Also, sometimes it is easier for youth to identify have about why the person killed themself. Similarly, if the death was ac-what they are experiencing via the instrument than to talk directly to cidental, youth may want to know related information, like how commonthe practitioner, especially when first meeting. Assessment tools can that type of accident is, and circumstances unique to the accidental death.also provide information about the youth’s strengths and competencies When young people are grieving due to a murder, assess for retaliatoryand provide an assessment of whether the youth is on track or has been thoughts and actions. Given the nature of the crime, having thoughts ofderailed developmentally as a result of the violent death. Traumatic grief wanting justice is normal and in some cases, justice may mean wanting toassessment measures have recently been developed and are undergoing have the perpetrator killed. It is often helpful to explain the criminal justicefurther development. These measures include the Extended Grief process to adolescents so they are informed of the procedures that mayInventory (Layne, Savjak, Saltzman, & Pynoos, 2001), Complicated Grief take place in terms of investigations, hearings and a trial. After a violentAssessment for Children and Adolescents—long form (Nader & Prigerson, death, practitioners and bereaved youth should explore any thoughts of re-2009) and Inventory of Complicated Grief, Revised (Melhem et al., 2007). taliation, involving other family members in the discussion who can offerOther measures that may be useful and are easy to administer are the strong messages that retaliation will not bring back the deceased or bringUCLA Posttraumatic Stress Disorder Index for DSM-IV (UCLA-PTSD- honor to the family and could potentially result in harm.Index; Pynoos et al., 1998), The Mood and Feelings Questionnaire–Child Coping StrategiesVersion (Angold & Costello, 1987) and the Child Behavior Checklist Promoting and teaching coping strategies is one of the core compo-(Achenbach & Rescorla, 2001). nents of trauma counseling (Amaya-Jackson & DeRosa, 2007). Coping “Why Did It Happen” and “Someone Has To Pay” skills have been associated with decreased distress (Deblinger, Manna- Adolescents have the cognitive capacity to explore multiple perspectives rino, Cohen, Runyon, & Steer, 2010). Exploring positive coping skills (i.e. 26 Continued on Page 27Volume 38, No. 2 • April 2012
  4. 4. Clinical Issues in ThanatologyTreatment for Adolescents After the Violent Death of Someone CloseContinued from Page 26active and adaptive coping rather than avoidant coping) to lessen distress Spirituality and Religioncan help the youth with the grieving process. Decreasing traumatic stress Exploring how the youth’s spirituality or religion may be providing com-may allow the typical grieving process to proceed without complications fort or confusion is also important after violent death. Ask questions suchof trauma (Cohen, Mannarino, Greenberg, Padlo, & Shipley, 2002). Other as: what beliefs or practices, including cultural practices, provide comfort?important coping strategies to promote include family, peer and other so- What beliefs have changed? Has the youth belonged to a religious group incial support, relaxation management, anger management, if needed, and the past or presently and if so, how has this group and/or the beliefs beenuse of spirituality, if relevant. of help? Have feelings about the religious group, God or a higher being Family, Peer Support, and Other Social Support changed since the death? For example, a 17-year-old boy whose mother Identifying and seeking social support is crucial to assisting the bereaved was killed by her boyfriend reported that he used to pray to God, but sinceadolescent after violent death. Social support is an important factor to help his mother’s murder, he did not want to pray or go to church. After the ther-buffer against posttraumatic stress. Many times after a violent death, the apist helped him to explore his feelings toward God and his confusion andyouth and other family members may be hesitant to talk with each other anger about “why God would let his happen,” he was able to start talkingdue to fear of intense emotions and not wanting to add additional burden with other family members about it and eventually started praying, ask-to others. Thus, the youth may feel family supports that may have been ing God and his mother to help him “do right” so that his mother would beavailable prior to the death are not available anymore. If possible, it is often proud of him.helpful to facilitate a family meeting so that members can talk with each Grief and Trauma Interventionother about their grief, discuss how different family members grieve, and After violent death, distressed bereaved youth need interventions thatwhat might be helpful to the whole family in coping with the death. can help lessen the distress that is often exacerbated by intrusive imag- Spending time with peers is important during adolescence, but some ery of the violent way the person died, high avoidance of people, places,peers may not know how to provide support or talk about what has hap- things and conversations related to the violent death, and increased hyper-pened. Practitioners can role-play with youth about how they may talk with arousal often leading to irritability, angry outbursts and difficulty in school.their friends about what they are experiencing or what would be helpful Youth who are experiencing grief and posttraumatic stress symptoms duefor them. Peer relations may help adolescents cope by providing distrac- to the violent death of someone close may benefit from a structured, em-tions such as going to movies, playing sports or “just hanging out.” Other pirically informed grief and trauma intervention. The intervention alsoways that peers can help bereaved youth cope include allowing emotional needs to be developmentally, ecologically and culturally relevant so thatexpression, providing understanding of their experience, and helping the the youth remains engaged in the treatment, and practical and applicableyouth to stay connected rather than withdrawn and isolated. However, in “real world settings” so that practitioners can implement the interven-peers may be a source of conflict if the youth experiences perceived or ac- tion.tual taunting about how the person died. For example, a 14-year-old youth Salloum and colleagues have been involved in a program of researchlied to his peers and told them that his father was murdered, when in fact and practice that uses practice to inform research and research to informhis father killed himself. He did not want his peers to know this for fear of practice that has been tested in a “real world setting” to develop an evi-being teased about his father being “messed up.” Adolescents who are in- dence-based grief and trauma intervention for children and adolescents.volved in an intimate peer relationship may find it very helpful. However, The Grief and Trauma Intervention (GTI), which has undergone severalin some instances, the youth may become more distant, having difficulty studies (e.g. Salloum, Avery, & McClain, 2001; Salloum, & Overstreet, S.remaining in the relationship which may lead to a breakup—another loss 2008; Salloum, 2008; Salloum & Overstreet, in press) employs cognitive be-that could further complicate the grief. Others such as teachers, neighbors, havioral and narrative therapy strategies to significantly reduce symptomsco-workers, mentors, religious leaders, extended relatives, other bereaved of posttraumatic stress, depression, and traumatic grief in children and ad-youth, and social network friends may provide support as well. olescents. The GTI treatment manual for adolescents has been published Relaxation (Salloum, 2004) and the GTI treatment manual for children is available at Teaching adolescents various deep breathing, muscle relaxation and GTI for children has recently been selectedguided imagery techniques can be very helpful to counter overwhelming for review for the SAMHSA’s National Registry of Evidence-based Pro-feelings of distress. These techniques can often be used when other cop- grams and Practices. While next steps involve additional research usinging skills, such as distraction by playing video games, are not appropriate GTI in different settings with different populations, we are also working(i.e. at school). on ways to disseminate the intervention that makes it more accessible to Anger Management practitioners. For more information about GTI visit www.childrens-bu- After a violent death, what would normally be anger may become rage, or e-mail the author.especially if someone was killed at the hands of another and “justice hasnot been served.” In these cases, helping the youth to manage his or her in- Referencestensive angry feelings often becomes a priority for keeping the adolescent Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-and others safe. age forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth & Families. Continued on Page 28 Volume 38, No. 2 • April 2012
  5. 5. April 2012 Clinical Issues in ThanatologyTreatment for Adolescents After the Violent Death of Someone CloseContinued from Page 27 Amaya-Jackson, L., & DeRosa, R.R. (2007). Treatment considerations for Angeles: UCLA Trauma Psychiatric Program. therapists in applying evidence-based practice to complex presentations Salloum, A. (2004). Group work with adolescents after violent death: A in child trauma. Journal of Traumatic Stress, 20, 379–390. manual for practitioners. Philadelphia, PA: Brunner-Routledge. Angold, A., & Costello, E.J. (1987). Mood and feelings questionnaire. Salloum, A. (2008). Group therapy for children experiencing grief and Developmental Epidemiology Program, Duke University. Retrieved from trauma due to homicide and violence: A pilot study. Research on Social Work Practice, 18(3), 198-211. Cohen, J.A., Mannarino, A.P., Greenberg, T., Padlo, S., & Shipley, C. (2002). Salloum, A., Avery, L., & McClain, R.P. (2001). Group psychotherapy for Childhood traumatic grief: Concepts and controversies. Trauma, adolescent survivors of homicide victims: A pilot study. Journal of the Violence, & Abuse, 3, 307-327. American Academy of Child and Adolescent Psychiatry, 40(11), 1261- Deblinger, E., Mannarino, A.P., Cohen, J.A., Runyon, M.K., Steer, R.A. 1267. (2010). Trauma focused cognitive behavioral therapy for children: Salloum, A. & Overstreet, S. (2008). Evaluation of individual and group grief Impact of the trauma narrative and treatment length. Depression and and trauma interventions for children post disaster. Journal of Clinical Anxiety, 0 (on line),1–9. DOI 10.1002/da.20744 Child and Adolescent Psychology, 37, 495- 507. Layne, C. M., Savjak, N., Saltzman, W. R., & Pynoos, R. S. (2001). UCLA Salloum, A. & Overstreet, S. (in press). Grief and trauma intervention extended grief inventory. Unpublished psychological test, University of for children after disaster: Exploring coping skills versus trauma California, Los Angeles. narration. Behavioral Research and Therapy. Melhem, M.D., Porta,G., Shamseddeen, W., Payne, M.W., & Brent, D.A. Zinzow, H. M., Rheingold, A. A., Byczkiewicz, M. Saunders, B.E., & (2011). Grief in children and adolescents bereaved by sudden parental Kilpatrick, D.G. (2011). Examining posttraumatic stress symptoms in a death. Arch Gen Psychiatry, 68, 911-91. national sample of homicide survivors: Prevalence and comparison to Melhem, N., Moritz, G., Walker, M., & Shear, K. (2007). Phenomenology and other violence victims. Journal of Traumatic Stress, 24, 743–746. correlates of Complicated Grief in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 46(4), 493-499. About the Author Nader, K., Pynoos, R., Fairbanks, L., & Frederick, C. (1990). Children’s Alison Salloum, PhD, is an assistant professor at the University of South PTSD reactions one year after a sniper attack at their school. American Florida, School of Social Work. She has developed and tested the Grief and Journal of Psychiatry, 147, 1526-1530. Trauma Intervention (GTI) for children. Dr. Salloum is the author of Group Nader, K. & Prigerson, H. (2009). Complicated grief assessment—Child Work with Adolescents after Violent Death: A Manual for Practitioners and adolescent scales, long-form. Austin, TX: Two Suns. (Brunner-Routledge, 2004) and Reactions: A Workbook for Children Pynoos, R. S., Rodriquez, N., Stienberg, A., Stuber, M., & Frederick, C. Experiencing Grief and Trauma (Centering Corporation, 1998). E-mail: (1998). The UCLA posttraumatic stress reaction index for DSM-IV. Los Students of AMF: Peer Support and Service as Therapeutic Supports AmongGrieving College StudentsContinued from Page 25 National-level Fajgenbaum, D., Chesson, B., & Lanzi, R. (in press 2012). Building a network of grief support on college campuses: A national grassroots • Attend the annual NSAMF National Conference on College Stu- initiative. Journal of College Student Psychotherapy. dent Grief in August 2012; Piliavin, J. A. (2003). Doing well by doing good: Benefits for the benefactor. • Serve as an Awareness Week Leader during National College In C. L. M. H. Keyes, Jonathan (Ed.), Flourishing: Positive psychology Student Grief Awareness Week in April 2012; and the life well-lived. (pp. 227-247). Washington, DC: American • Share information about NSAMF with colleagues; Psychological Association. Servaty-Seib, H. L. (2006). Educational performance and persistence of Consider offering your supportive guidance through volunteering bereaved college students. Journal of College Student Development, 42,for NSAMF, serving on an advisory board, or conducting quantitative 225-234.research into the effectiveness of our programs. Wrenn, R. L. (1999). The grieving college student. In J. D. Davidson & K. J. Doka (Eds.), Living with grief: At work, at school, at worship (pp. References 131-141). Levittown, PA: Brunner/Mazel. Balk, D. E. (2001). College student bereavement, scholarship, and the university: A call for university engagement. Death Studies, 25(1), About the Author 67-84. David Fajgenbaum, MSc (Public Health), is a third-year MD/MBA Balk, D. E. (2008). Grieving: 22 to 30 percent of all college students. New student at the University of Pennsylvania and the co-founder & Board Chair Directions for Student Services 121: 5-14. of National Students of AMF. David is the president and support group Balk, D. E., Walker, A. C., & Baker, A. (2010). Prevalence and severity of leader of the University of Pennsylvania chapter of Students of AMF and college student bereavement examined in a randomly selected sample. remains involved with the daily operations of the nonprofit. E-mail: david@ Death Studies, 34(5), 459-468. 28Volume 38, No. 2 • April 2012