So beautifully put Robin! Thank you! Grief SO can't be quantified by a number. And it's been my experience as well that some of the situations that look the worst on paper (for example, in our risk assmnt in HCHB, if there are children in the family you are doomed to have extremely complicated grief, no questions asked...) but in reality the persons involved have incredible coping mechanisms and are grieving in very healthy ways. I almost wish we could just have one question - "Do you think I should contact the bereaved sooner than later?". I've gotten some wonderful responses from this NHPCO group and will be trying to connect individually to share ideas.
This is a bit of a different subject, but I've found that our number of more "complicated" bereaved increased fairly significantly in 2018 compared to 2017. And this is after I've assessed them after the death, not just prediction before the death. I'm finding that more folks I'm talking with have experienced multiple deaths or other losses, more suicide and chemical related deaths within the family (not just our patients) , and SO many more families with conflicts or estrangements within the family. Seems like some reflection of the world we're living in now. Is anyone else noticing this?? Thanks for any thoughts...This group has been a God-send to me :)
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Lori Williams, MSW, LISW
St. Luke's Hospice Duluth, Social Worker/Bereavement Coordinator
Duluth, MN
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Original Message:
Sent: 01-15-2019 12:17
From: Debra Darby
Subject: Bereavement Risk Assessment tool
Hi Robin,
Great synopsis of the problem. You cannot quantify a grief response, you need a personalized narrative to assess risk.
How to put this into professional practice is another issue.
Best,
Debra Darby MSW LISW
Bereavement Coordinator, St. Croix Hospice
Original Message:
Sent: 01-15-2019 11:31
From: Robin Fiorelli
Subject: Bereavement Risk Assessment tool
Hi all
in my mind, you both have illustrated the problems with numerical risk scales. I know you are constrained by having to use the software you have, but many of us have concluded that the use of a grief risk scale only tells a PART of the story. it is tool, like a depression inventory and the like, that gives us partial information only. A simple example to illustrate this: there are some bereaved who have maybe even multiple risk factors- BUT they have a personality profile or enhanced resiliency, strong faith or something (or a combo of things) that enable them to weather adversity.
We all believe that everyone's grief response is completely unique. I think because hospice is a healthcare entity we are trapped by number crunchers wanting to quantify grief so that they can establish outcome measurements. That just does not work with grief. it may work better for physical symptoms. We can't quantify human subjective emotions and behavior. I worry that surveyors will want to see specific bereavement interventions based on risk. As you two demonstrated, that just does not work!
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Robin Fiorelli LCSW
Sr. Director of Bereavement and Volunteers
VITAS
Original Message:
Sent: 01-14-2019 09:26
From: Debra Darby
Subject: Bereavement Risk Assessment tool
Hi Lori,
We also use the risk assessment provided by Homecare Home Base (HCHB), and I am finding that it does not accurately reflect risk at times. I have a number of "low" risk bereaved that I am following at a moderate level, primarily because they have little support and are very isolated. I would be interested in your thoughts about modification, and having an ongoing conversation about risk.
Thanks,
Debra Darby MSW LISW
Bereavement Coordinator, St. Croix Hospice
ddarby@stcroixhospice.com
Original Message:
Sent: 01-11-2019 10:28
From: Lori Williams
Subject: Bereavement Risk Assessment tool
Hello - I'm wondering if anyone, and hopefully some users of Homecare Home Base (HCHB), could share a Bereavement Risk Assessment that they've found to be effective as a starting point for assessing bereavement risk for folks. I've been struggling with the one that came with the system and am hoping to find one that better reflects bereavement concerns so as to flag me to contact the higher risk bereaved sooner rather than later. Right now I'm trying to juggle bereaved who land numerically (because of the risk assessment we have) in low risk "but I'm really concerned about them" or moderate to high "but I think they'll be fine". And with me trying to follow over 500 bereaved, it's not possible to keep track of all of those. I've looked back at previous discussions on this and will research some of those mentioned. Thank you for any help!
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Lori Williams, MSW, LISW
St. Luke's Hospice Duluth, Social Worker/Bereavement Coordinator
Duluth, MN
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