Adult Bereavement Care Pyramid
A National Framework
In the absence of a national approach to adult bereavement care in Ireland, the Irish Hospice Foundation facilitated a national collaborative process to develop a framework for adult bereavement care in Ireland.
This tiered framework was developed to guide those working and supporting bereaved people in Ireland. It aims to help those who meet people who are bereaved in their day to day work (e.g. General Practitioners, Citizen Information Service etc.) and those who provide direct bereavement support (i.e. information resources, group or individual support, counselling and mental health professional interventions) to identify and respond appropriately to adults who have experienced a loss.
Zoom in to the adult bereavement care pyramid image
Development of the framework
The ‘Enhancing Adult Bereavement Care across Ireland’ report of a national consultation was published in 20182 and identified a common set of core concerns among those who encounter bereaved people as part of their work. The lack of a common framework for bereavement care in Ireland was identified and prioritized by the report’s project advisory committee (PAC)3.
In considering the report findings (which included a literature review and consultation with service providers across the country) and the evidence for a public health approach to bereavement care, the PAC adapted the Irish Childhood Bereavement Care Pyramid for adult bereavement care. This tiered pyramid-based framework, along with the report findings, was presented at the third National Bereavement Forum (NBF) in June 2018 hosted by the Irish Hospice Foundation. Forum attendees engaged in a structured feedback process.
Subsequently, a short term project committee was set up in September 2018 to develop this framework further. The committee members stemmed from organisations represented at the 2018 National Bereavement Forum and included representatives of providers at all levels of service provision, both State and NGO sector and from organisations across the country.
The current framework was finalized through a consultation process. The framework, accompanying leaflet and a survey was sent via SurveyMonkey to services/supports at all levels of the pyramid, both the statutory and the NGO sector and national, local and international stakeholders.
This has been a collaborative process which has been project managed by the Irish Hospice Foundation (supported by the Health Service Executive). This framework places bereaved people’s needs at the centre and sets out to clarify the appropriate support/services and competence required to meet basic through to complex bereavement needs.
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, such as the need for compassion and acknowledgement of the death (LEVEL 1).
SOME need additional support which is outside their natural network, such as peer to peer support (LEVEL 2).
SOME require a more intensive support, such as counselling (LEVEL 3) and a FEW require support from a specialist therapeutic service (LEVEL 4).
In addition to identifying the varying levels of NEED experienced by those who are bereaved, the framework also outlines the SUPPORTS/SERVICES appropriate to meet each level of need and the recommended KNOWLEDGE/SKILLS required by those providing support at each of the four levels.
There are many factors which impact a person’s experience of bereavement. The framework acknowledges this and their impact on the bereaved person’s needs and the support they require. These factors are highlighted within this framework under three headings, the bereaved person’s SOCIAL NETWORKS, the CIRCUMSTANCES surrounding the loss, and TIME.
The SOCIAL NETWORK refers to 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 is important that the person considers the support they receive from their network as helpful.
CIRCUMSTANCES surrounding the loss include the circumstance of the death itself and the bereaved person. Circumstances 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 experienced as 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.