Bereavement Professional

Debbie,

Great question!  Not sure if others have sent you specific examples on the sidelines. Here are components I see frequently gathered in a screening/orientation to group. What do others include?

Name

Intake Date

Preferred Phone

E-mail

Address

Name of Deceased

Date of Death

Relationship to Deceased

Hospice? Yes/No

Program

Cause of Death

Location of Death

Additional Significant Losses

Primary concern/reason for seeking support

Identified support system (family, friends, church community, pets):

History and/or current depression, anxiety, other chronic mental health issues, suicidal, etc.:

Currently under the care of a psychiatrist, psychologist, counselor, other mental health professional?

Increase alcohol or drug use?  Does your use concern you or others?

Are you or was your loved one a Veteran?  Yes / No 

Active Duty? Yes/ No  

Combat? Yes/ No

Branch?

Participation in other support groups?

Other friends/family attending this group?  Yes / No.  If so, who?

Day of week/time preference for group?

Commitment to attend all sessions? Yes / No.  If No, date(s) and reasons?

Referral Source?

Since we have multiple coordinators we also have a guide for the coordinators to utilize during screening with scripting, FAQs, and more to help ensure that during the screening it also serves as an orientation to group for the interested person, and helps us to be consistent.

Joelle Osterhaus, MSW, LCSW, LICSW, ACHP-SW (she/her)
KPNW Hospice & Palliative Care Psychosocial Services Manager

NHPCO Bereavement Professionals Community Steering Committee, Chair

"Although the world is full of suffering, it is also full of overcoming it." - Helen Keller

Kaiser Permanente Northwest
Continuing Care Services 2701 NW Vaughn St., Ste. 140, Portland, OR 97210-5344

Cell Phone: (503) 312-0819
Main Office: (503) 499-5200

Fax: (503) 499-5535

Bereavement Program Sharepoint Site: https://sp-cloud.kp.org/sites/teams-nwreg-NWAmbulatoryCare/CCS/Hospice/SitePages/BS.aspx

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Good question!  By regulation there are not required waivers for group participation, however, each bereavement program should review with their own leadership (quality manager, executive director, board of directors, or legal counsel), to determine if any additional forms would be best practice to include in individual or group services.

For example, for groups or workshops that include movement like yoga, hiking, walking, or a children's camp with many play based activities, perhaps they'd want to develop a liability waiver?  While our programs do not offer anything like that at this time, I have in other agencies and in those circumstances developed and used a waiver.

I also know many programs opt to have consent forms for their individual and group support services which outline the scope of those services (number of sessions/meetings, goal of the service, that it is not therapy), discuss privacy/confidentiality (and make a copy of the hospice's privacy practices document as well), capture any state specific laws that could apply, note what happens if scheduled sessions are missed, and the like. Some programs have separate consent forms for children, teen and adult bereaved. 

In the programs I have worked in the bereavement staff have felt this was best practice given their licensing and/or professional ethics, and we also received positive feedback from those receiving support that they found these forms helpful to them when beginning services as well.

Joelle Osterhaus, MSW, LCSW, LICSW, ACHP-SW (she/her)
KPNW Hospice & Palliative Care Psychosocial Services Manager

NHPCO Bereavement Professionals Community Steering Committee, Chair

"Although the world is full of suffering, it is also full of overcoming it." - Helen Keller

Kaiser Permanente Northwest
Continuing Care Services 2701 NW Vaughn St., Ste. 140, Portland, OR 97210-5344

Cell Phone: (503) 312-0819
Main Office: (503) 499-5200

Fax: (503) 499-5535

Bereavement Program Sharepoint Site: https://sp-cloud.kp.org/sites/teams-nwreg-NWAmbulatoryCare/CCS/Hospice/SitePages/BS.aspx

NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them.  Thank you.