Adult Bereavement Care Pyramid: A National Framework
In the absence of a national approach to adult bereavement care in Ireland, we facilitated a national collaborative process to develop a framework to guide those working with and supporting bereaved people across the country.
It places bereaved people’s needs at the centre and shows the appropriate support/services and competence required to meet basic through to complex bereavement needs.
The aim of this tiered framework is to help those who meet people who are grieving in their day-to-day work (general practitioners, citizen information services etc.) and those who provide direct bereavement support (group or individual support, counselling and mental health professional interventions) identify and respond appropriately to adults who have experienced a loss.
Download a larger image of the Adult Bereavement Care Pyramid.
How to Use the Framework
The framework is based on a pyramid model which suggests that all people who experience a bereavement have some level of need, like the need for compassion and acknowledgement of the death (Level 1). Some will need additional support outside their natural network (Level 2). Some require more intensive support, like counselling (Level 3) and a few require support from a specialist therapeutic service (Level 4).
In addition, pyramid also identifies the supports/services appropriate to meet each level of need and the recommended knowledge/skills required by those providing support at each of the levels.
There are many factors which impact a person’s experience of bereavement. These factors are highlighted within the pyramid under three headings, the bereaved person’s social network, the circumstances surrounding the loss, and time.
Social Network
This is the support provided by people in the bereaved person’s social network, such as their family, friends, work colleagues, cultural community, faith community etc. It’s important the person considers the support they receive from their network as helpful.
Circumstances
Circumstances surrounding the loss include the circumstance of the death itself and the bereaved person. These may include the care received by the deceased and the bereaved person before/at the time of the death, a sudden or expected death, if the death was traumatic etc. Aspects relating to the bereaved person, such as their culture, beliefs, personality, previous experience of loss etc. will also have an impact on the bereavement experience.
Time
Plays a role in the experience of bereavement and can include the length of time since the death or the time in a person’s life the death occurs. In addition, how someone experiences bereavement can change over the course of their lifetime. For example, after the death of a spouse, a person may experience pangs of grief at significant events, such as a graduation, a wedding, birth of a grandchild etc. However, grief may be revisited at any time.
Although many bereaved can adapt to the loss with Level 1 support some need the more intensive supports available at the higher levels. The referral and signposting services at Level 2 are integral to the framework as they can ensure a person accesses the appropriate level of service provision to meet their needs. Thus, good assessment is key to identifying the level of support/ service that would best meet the needs of the person.
Supports/services at all levels should be available and accessible to all that need them and access should not be restricted due to geography or cost. It is important to note that a person’s needs can evolve and change over time.
Development of the Framework
The ‘Enhancing Adult Bereavement Care across Ireland’ (2018) report established a vision for a national approach to bereavement care in Ireland and set out an implementation framework to enhance bereavement services nationwide. The report included a rapid systematic literature review of international evidence to understand and compare bereavement care policy, standards, structures, guidance, and supports in Ireland, the UK, Canada, Australia, and the Netherlands. It also incorporated findings from focus groups and interviews with bereavement service providers across Ireland.
The review identified a common set of core concerns among bereavement care providers who encounter bereaved people as part of their work. A key finding was the absence of a shared national framework for bereavement care in Ireland. Addressing this gap was prioritised by the report’s Project Advisory Committee.
Following publication of the report, a working group comprising lead bereavement service providers and representatives from the wider social and health sectors was established to develop a tiered, pyramid-based framework for adult bereavement care in Ireland. This process involved adapting Irish Childhood Bereavement Care Pyramid (2015) for adult services, alongside integrating findings from the 2018 report. These findings highlighted the evidence base for a public health approach to bereavement care, as well as national and international tiered models of care (e.g. Schut et al. 2001; NICE, 2004; Walsh et al. 2008; Petrus et al, 2008; Aoun et al., 2012, 2015). The most recent of these, Aoun et al (2015), identified proportions of the bereaved population at risk, but crucially emphasised that all bereaved people have needs, and that these needs are met in their natural community.
This framework was finalised following a broad consultation process involving services and supports across all levels of the pyramid, including statutory and NGO sectors, as well as national, local, and international stakeholders. This collaborative process was project managed by us here at Irish Hospice Foundation (supported by the Health Service Executive). For more details about the framework and how to use it, download this helpful booklet.
Bereavement Support Core Competency Framework and eLearning – Level 2
In 2024, Irish Hospice Foundation, in collaboration with the Bereavement Training Network, developed the Bereavement Support Core Competency (BSCC) Framework and accompanying eLearning for bereavement service providers operating at Level 2 of the Adult Bereavement Care Pyramid and Irish Childhood Bereavement Care Pyramid. The BSCC Framework and eLearning were developed after identifying the need for agreed standards, competencies, and training for Level 2 bereavement care services in Ireland.
Learn about the BSCC Level 2 Framework and eLearning.
