Note to readers • This story is excerpted from a national version produced by MindSite News, the country’s only news site focused on mental health reporting.

Amanda Joyce Jensen will always remember the night she told her 4-year-old son, Kezman, that his father, Marshall, had died of cancer — and how Kezman said he already knew because “Daddy came to me first.”

The Woods Cross boy cried as he drew a picture of his dad standing at the end of the hallway, wearing a red superhero cape, flying into his thoughts.

The euphemisms that adults often use to soften the shock can be confusing to a child of such a young age — that someone is “lost” or “passed away” — so his mother talked with Kezman gently but directly. He grasped more clearly than she had imagined that his father was gone and never coming back.

As life without Marshall stretched before them, Kezman’s grief emerged without words. He screamed like he was being tortured when she cut his hair or had sudden bursts of intense energy when she was trying to settle him down for bed. Sometimes she wasn’t sure if his behavior was typical of a 4-year-old boy or a signal of his grief.

Then one day his mother took Kezman to The Sharing Place, a child and family grief center in Salt Lake City, and he jumped into a pile of foam. There, in the Volcano Room, he also threw giant plastic balls against padded walls and climbed on pillows. In a playroom, he built contraptions with Legos, and in the art room he colored with markers.

During each visit, he could talk about his dad in a circle with other young kids who’d lost a parent or sibling while Jensen, a health coach, met in a group with bereaved parents who also were struggling to recreate their lives.

The results were transformative.

“My son needed something that I couldn’t give him,” she said. “I just noticed how much better he did in school, how much better he did socially, when he had a place where people understood a little more” what he’d gone through.

After two years, she and Kezman sought a fresh start by moving to St. George, where there was no grief support group for children — what some researchers are calling a “bereavement desert.” Instead, for about a year, Jensen started driving her kindergartener back to The Sharing Place from southwestern Utah every other week, an exhausting trip of four hours each way.

Still, Jensen and Kezman were in some respects fortunate. Hundreds of thousands of children lose a parent in the U.S. each year, and most have no access to counseling or grief support groups. They may not even know such services exist.

Bereaved children — the forgotten children left behind after the death of parents, caregivers, and other close family members — are rarely a part of the national conversation about gun violence, drug overdose deaths, deadly diseases or other health threats. Indeed, in most parts of the country, there is no system in place to identify children who have experienced the death of parents or other caregivers, so they can be offered services.

In Utah, at least, that’s starting to change.

On July 25, 2023, Gov. Spencer Cox issued an executive order making Utah the first state to add a question on its death certificate form asking if the deceased person had surviving children. From that date through the end of 2024, the state has identified 1,448 families with children under 18 who have lost a parent or caregiver.

Through a partnership with United Way, a team of outreach coordinators has begun reaching out to the families to connect them with counseling, grief groups and other resources.

“The goal is for these kids to have the opportunity to receive the services that they could and should be getting,” said Nate Winters, deputy director for operations at the Utah Department of Health and Human Services.

‘There’s a great need’

The death of a parent is one of the most traumatic of the adverse childhood experiences (ACEs) that can derail emotional development and lead to long-term problems, including depression, behavioral issues, or academic problems in school.

Child grief support and “resilient parenting” strategies can help protect against those bad outcomes — as evidenced in studies that followed children for as long as 15 years after the sudden loss of a parent.

But even as the combination of COVID-19 and a steep rise in gun violence and drug overdoses pushed parental deaths up by 46% during the first two years of the pandemic, access to grief support failed to match the need. In 2021, an estimated 2.9 million U.S. children under the age of 18 — about 4.2% of all kids — had lost a parent or primary caregiver, according to a January 2025 analysis published in Nature Medicine.

And each year, the toll of childhood bereavement grows: By the time they turn 18, almost one in 13 children — 5.4 million in all — will experience the death of a parent, according to 2024 estimates from the JAG Institute, a research initiative of Judi’s House, a grief center for children and families in Aurora, Colorado.

Some communities are even more severely impacted. One in six American Indian or Alaska Native children and one in nine African American children will experience the death of a parent before they turn 18, the JAG Institute estimates. Yet communities of color and rural areas often lack grief support centers that serve bereaved children and their families.

“There’s a great need, and we could be meeting that need but we’re not,” said Micki Burns, chief executive officer of Judi’s House. “And right now, unfortunately, the resources are hard to find.”

The Utah effort aims to create a model that other states can replicate.

The outreach coordinators, for example, notify the families of a critical resource that bereaved children often miss out on: Social Security benefits. Surviving children of a deceased parent are eligible for a monthly benefit based on that parent’s previous earnings, but only about 45% of them apply and receive it, according to a 2019 analysis by David Weaver, a statistician and economist at the University of South Carolina.

Those who don’t apply are forgoing a benefit with an average monthly value of $1,441 per family in 2024 – an amount that could make a big difference to families struggling with a loss of income amid their grief.

The Utah effort is spearheaded by the Children’s Collaborative for Healing and Support, a nonprofit organization that aims to develop support networks for families that have experienced the death of a parent or caregiver.

In Salt Lake County, the collaborative worked with the Granite School District to add a question about bereavement to annual school registration forms as another way to identify grieving children. Now the collaborative is working with partners to create similar systems across the country that can identify bereaved children, connect them with financial assistance, and provide them with grief support.

The economic cost of childhood grief

Most grieving kids can be helped with a peer-support model similar to what Kezman Jensen received. That support reduces the risk that they’ll develop depression, learning problems and other academic, social or emotional difficulties.

Behavioral changes after the death of a parent or other close family member can also include withdrawal, bursts of anger, or dangerous risk-taking. Roughly one in 10 children will experience “complicated grief” that is intense, persistent and disruptive and requires treatment from a mental health professional.

Grief ripples through families and communities, but the failure to support bereaved children has a much wider impact, said Catherine Jaynes, president and CEO of the Children’s Collaborative.

“For states and localities to not take care of these children, what is the economic cost?” she said. “What is the cost to the children that are impacted from an education perspective, from an incarceration perspective, from an earnings perspective?”

A variety of studies show that children who have experienced the death of a parent are less likely to attain a college degree or even to graduate from high school. Black and Native American children have the highest rates of parental loss, so their educational prospects are disproportionately affected — an outcome that University of Minnesota researchers highlighted as “a form of structural racism.”

Over their lifetimes, children who drop out and don’t get a high school diploma earn about $1.6 million less than those who obtain a bachelor’s degree. Collectively, that means bereaved children lose billions of dollars in lifetime earnings.

Helping children left behind

The need for connection has been the catalyst for grief centers serving children and families; they often are launched by someone who was impacted by loss as a child or by a parent who couldn’t find help for their own grieving children. The National Alliance for Children’s Grief lists more than 400 locations that offer some form of peer-based grief support, including camps, centers, or hospice programs.

Still, communities with the highest rates of parental deaths often lack the resources to help the children left behind.

Efforts are underway in some states to change that. In Michigan, for example, researchers from Wayne State University and the University of Michigan are mapping parental deaths from drug overdoses and other causes alongside the locations of programs that offer support.

They are identifying “bereavement service deserts,” where grieving children and their families have few or no local resources, “so that we can reach them and deliver services that will improve their health,” said Sean Esteban McCabe, director of the University of Michigan Center for the Study of Drugs, Alcohol, Smoking, and Health.

HopeHQ, a joint project of the universities, provides information on resources for grieving children and their caregivers who have experienced the death of a parent or family member from a drug overdose. And the state has launched a website that enables users to search for grief support and other bereavement resources by ZIP code.

Nationwide, schools also are a primary site for grief support. In January 2024, the New Jersey Legislature passed a law adding grief education to the health education curriculum for grades 8 to 12. Maryland, Connecticut, and Massachusetts have similar policies.

‘Families are forever’

Back in Salt Lake City, The Sharing Place is bustling. In one room, kids are drawing and sculpting. In another they make dinner at the toy kitchen or act out family life at a dollhouse. Upstairs, teens are engaged in a game of Jeopardy.

But the pictures they draw reflect their loss. The Jeopardy game is designed to help teens talk about their grief. A writing wall pays tribute in simple words: Dad was nice. Families are forever. Here, children can act out their feelings, speaking aloud words they wish they could say to a parent or sibling who died.

There’s a waiting list to get a spot in a child grief support group, even though three locations in Utah offer a total of 31 biweekly groups for children ages 3 to 18 — and parallel groups for parents or caregivers.

About 120 volunteers work alongside group coordinators, helping to guide the activities and circle time, where children and teens hold a “talking stick” and share what they miss about someone, what happy memories they have, what they regret, what makes them feel angry.

About 22% of the families come from outside Salt Lake County to attend grief programs, some driving an hour or more.

Executive director John Gold is exploring the possibility of opening a center in St. George, where Amanda Joyce and Kezman Jensen live. There are other families who need support there who can’t make the drive as they did. “It’s my mission and the board’s mission to make this a statewide organization because the need is so great,” Gold said.

Today Kezman is 13 and in 8th grade. His mom marvels at how much he resembles his father – not just physically, but in his spirit and talents. He plays guitar and writes songs, works hard at school, and helps his mother at events that raise money for cancer research and services. “His father was a really good man, and he is a good kid,” she said.

The time Kezman spent at The Sharing Place from the age of 4 to 7 helped him learn that he was not alone in his loss. “(He realized) there’s a lot of people that go through hard things, and they have different lives than they felt that they would. He just handles it really well,” said Jensen, who wrote an inspirational memoir based on her experiences, called Marshalling Beats of Your Heart.

Jensen and her son recently went to a fundraising event for The Sharing Place, and she promised Gold she would do what she could to help him bring his program to St. George so that other families can benefit. “I just can’t be more grateful for having what we did have at a time when we needed it so much,” she said.

Note to readers • Reporting for this article was supported by the USC Annenberg Center for Health Journalism’s 2024 National Fellowship and its Kristy Hammam Fund for Health Journalism and by the Commonwealth Fund. Sign up for the MindSite News newsletter here.