Bereaved people have different needs at different dimensions. In addition, in view of the limited manpower and resources, it is crucial to offer suitable and specific supports for the bereaved people in need. A public health approach to bereavement care provision has been proposed (Aoun et al., 2012), which includes a three-tiered intervention targeting different populations. The National Institute for Clinical Excellence also suggested specific bereavement care for people at different tiers (NICE, 2004). In order to offer a comprehensive framework for bereavement care, we are proposing a three-tiered framework with corresponding assessment tools and intervention work. These tiers comprise universal care for the entire population, selective care for high-risk groups, and indicated care for highly distressed individuals.
Universal care
Target recipient: All bereaved people
Content of care:
Grief is the normal response to the loss of our beloved ones. All bereaved people need information about grief and accesses to services. The information should be written and prepared by professionals, but may be dispersed through non-professional people like family and friends, workplace, people in the community, as well as anyone who may offer care for the bereaved. The information may also be obtained through website, social media or publications. As long as the person may demonstrate adequate understanding of bereavement, care and supports offered by people from the informal social network are especially precious for the bereaved.
Selective care
Target recipient: High-risk bereaved people
Care content:
Bereavement risk screening tool is used to identify the high-risk bereaved persons. They are the bereaved who are at a higher risk to be affected by intense grief reactions and hence need additional supports. People from this high-risk group need a more formal platform to review and reflect on their own bereavement experience. Bereavement care at this level may be offered through individual work or groupwork, and can be provided by helping professionals, as well as volunteers, people from community and religious groups who have received corresponding training. During the process of review and reflection, a preliminary outcome assessment can be made through a natural process of sharing by the bereaved person. Therefore, a referral guideline with clear instruction is needed and the bereaved person can be referred to the next tier for extra care when they demonstrate high distress from the bereavement experience.
Indicated care
Target recipient: Bereaved people who have high distress or severe impairment in daily functioning
Care content:
Bereavement outcome assessment tool is used to identify the bereaved persons who have shown high distress and severe impairment in daily functioning. This relatively small group of bereaved people would need specific supports from helping professional for individual bereavement counselling and mental health services.
Bereavement care is comprised of “universal care”, “selective care” and “indicated care” according to the different needs of bereaved people. A bird’s eye view shows that all bereaved people (100%) would need universal care, and people who need additional supports can be identified by Bereavement risk screening tool and Bereavement outcome assessment tool for corresponding interventions at the next tier.
(Remarks: The illustration of a cone-shaped diagram is inspired by the discussion made from the Public Health Workgroup of International Workgroup on Death, Dying and Bereavement 2022)