welcome [ ] · pdf filec u l t u r e p r o l o n g e d g r i f fig. 3: complicated grief p e r...
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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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