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Welcome

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Aims:

A brief overview of service development and delivery An insight into complicated/prolonged grief and how we currently identify those at risk

An insight into the client experience

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Early Intervention

“In our pilots 45% of bereaved people took up

the offer of the follow up support service, 5.4%

of the people using the service requested six or

more telephone calls and at the end of the

support 0 out of 209 people using the service

required further bereavement support and the

vast majority expressed what an excellent

service they had received”

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Project Purpose & Aims

“Early intervention to prevent the onset of complicated /prolonged grief in recently bereaved people”

“The project aims to deliver better health outcomes for those most profoundly affected by a death in the previous 6 months”

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Fast track service 6 – 8 50 minute 1: 1 sessions Using tailored and common measurement tools in conjunction with talking therapies Via remote mediums – telephone Between 9am & 9pm Mon - Fri

Flexible modality Client’s are over 18 and based in England

Strategy

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“grief becomes a mental illness when over time, grieving individuals are so disabled by their loss that they can no longer function effectively in key social roles – home, work, or school.”

Nancy Boyd Webb’s notion of disabling grief

Current Issues in Grief Theory : Colin Murray Parkes

Colin Murray Parkes

http://www.cruse.org.uk/sites/default/files/default_images/pdf/Events/ColinMPcomplicatedgrief.pdf

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Assessing the needs of bereaved people: Bereavement Care in Practice

“Most people come

through the stress of

bereavement without

suffering lasting damage

to their physical or mental

health; indeed, most grow

more mature and many

become more sensitive to

the suffering of others”

“A minority of those who

suffer a bereavement are at

risk of suicide, psychiatric

disorders (notably major

depression, anxiety/panic

disorders, pathological grief

and post-traumatic stress

disorders, physical health

problems…and

psychosomatic disorders

(notably identification

syndromes and physical

accompaniments of anxiety)”

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Provide immediate containment

Offer coping strategies

Prevent stagnation of issues

Constructively help those most in need: flexibility & medium

Increase accessibility

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Disabled People

Socially disadvantaged groups

Faith groups Elderly People

Young people

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Maladaptive coping strategies

Physical health issues Mental health issues

Social isolation Dysfunctional family dynamic

Maladaptive activity

Suicidal ideation

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R e l a t i o n s h i p t o d e c e a s e d

Complicated Grief

Bereavement E x i s t i n g M H

C h i l d h o o d L o s s

E x t e r n a l s t r e s s o r

I s o l a t i o n

P r e f e r e n c e f o r o r d e r

C i r c u m s t a n c e o f B e r e a v e m e n t

E x t e r n a l s t r e s s o r

C u l t u r e

PROLONGED GRIEF

Fig. 3: Complicated Grief

P e r s o n a l i t y

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DSMV Classification of prolonged grief

On-going research into Prolonged grief Best practice

Media attention since 2005

P r e - A s s e s s m e n t

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Re fe r ra l fo r m c r i te r i a

SLA: Has the death happened in the last 6 months?

S L A : D o t h e y l i v e i n E n g l a n d ?

C lose re lat ionship to the deceased

Death in hospital

S u d d e n o r u n e x p e c t e d l o s s

Caller mentions they had a difficult childhood

D id the death happen abroad?

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Assessment process

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A s s e s s m e nt fo r m c r i te r i a S L A : H a s t h e d e a t h h a p p e n e d i n t h e l a s t 6 m o nt h s ? Wa s i t a d e p e n d a nt r e l a t i o n s h i p ? Wa s t h e l o s s u n ex p e c te d ? D i d t h e c a l l e r l o s e a p a r e nt w h e n t h e y we r e a c h i l d ? H a s t h e c a l l e r m e nt i o n e d a p r e fe r e n c e fo r o r d e r a n d s t r u c t u r e ?

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M a i n l o s s e s d e s c r i b e d a s f o r e x a m p l e

- c a r e r - s u p p o r t - c o m p a n i o n - s o u l m a t e

H e a l t h A n y f o r m a l p r o c e s s e s s u c h a s i n q u e s t

R e l e v a n t l i f e h i s t o r y e . g .

- p r e v i o u s s i g n i f i c a n t l o s s e s - a n y u n f i n i s h e d b u s i n e s s - a n y h i s t o r y / i n d i c a t i o n s o f d e p r e s s i o n

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D o e s t h e b e r e a v e d i n d i v i d u a l s e e m t o b e - W i l l i n g / a b l e t o e x p r e s s f e e l i n g s ? - W i l l i n g / a b l e t o e x p r e s s t h o u g h t s ? - W i t h o r w i t h o u t h o p e ? A n y i l l u s t r a t i o n o f t h e f o l l o w i n g B e h a v i o u r s

- M i n i m i s a t i o n o r d e n i a l o f f e e l i n g s ? - S i g n s o f s e l f - n e g l e c t ? - S i g n s o f s e l f h a r m ? - S u i c i d a l t h o u g h t s / i n t e r v e n t i o n s / a t t e m p t s ?

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I s t h e n a t u r e o f g r i e v i n g

- I n te n s e - O v e r w h e l m i n g - A b s e nt - S t u c k o r c h r o n i c C h a ra c te r i s e d b y s t r o n g fe e l i n g s o f - A n g e r - G u i l t - Fe a r

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Early Intervention

Coping Strategies

Risk

Existing MH

Childhood Loss

Preference for order

Circumstance of Bereavement

External stressor

Relationship to deceased

Culture

NORMAL GR IEF

Fig. 4: Complicated Grief

Talking

therapies

Compass

Containment

P e r s o n a l i t y

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CORE - 10 (Session-by-session monitoring, review or quick initial assessment)

A short, 10 item version of the CORE-OM to be used as screening tool and outcome measure when the CORE-OM is considered too long for routine use. Items cover anxiety (2 items), depression (2 items), trauma (1 item), physical problems (1 item) functioning (3 items - day to day, close relationships, social relationships) and risk to self (1 item). The measure has 6 high intensity/severity and 4 low intensity/severity items.

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The Bereavement Compass is an easy-to-use monitoring tool, designed to help the client assess their own coping in eight different areas of life. Volunteers introduce the Bereavement Compass in the first or second session and invite the client to scale how they feel they are coping in each of the areas indicated on the Compass.

The Bereavement Compass

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T h e B e r e a v e m e n t C o m p a s s p r o m o t e s s e l f -m o n i t o r i n g b y c l i e n t s b o t h d u r i n g t h e i n t e r v e n t i o n a n d o n c e t h e y h a v e f i n i s h e d t h e i r b e r e a v e m e n t s u p p o r t s e s s i o n s . B y e n c o u r a g i n g c l i e n t s t o t a k e o w n e r s h i p o f t h e m o n i t o r i n g p r o c e s s , a s w e l l a s t h e s e s s i o n s t h e m s e l v e s , t h e C o m p a s s p r o m p t s b e r e a v e d p e o p l e t o b e c o m e a w a r e i n a d v a n c e o f t h e e v e n t s o r a n n i v e r s a r i e s t h a t m i g h t t r i g g e r p e r i o d s o f o v e r w h e l m i n g g r i e f , a n d t o p l a n a h e a d f o r t h e s e .

1 is very bad 3 poor 5 average 8 good 10 excellent.

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96% of people who accessed ongoing support and returned a feedback form reported feeling ‘better’ or ‘much better’ at the end of their sessions. When asked how much they attributed this change to the support they received through the project, 4% felt that the support had made no difference, 33% felt it had made some difference, and 67% felt it had made ‘quite a lot’ of difference.

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E x p a n d t h e s e r v i c e a c r o s s t h e C r u s e N e t w o r k

W o r k w i t h r e s e a r c h e r s

t o i m p r o v e o u r m e t h o d s

R a i s e p u b l i c a w a r e n e s s

D e v e l o p f a s t t r a c k F : F s e r v i c e s

W o r k w i t h y o u n g p e o p l e

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