Which would be the best way to organize good bereavement support: primary healthcare, internet, support groups, based on information, specialized services, based on stepped care, or others options?
Probably the first place to start is to distinguish the very different user groups: men/women, children/adults, traumatic loss/other, etc. While some grief counseling services, in the US at least, take a "one size fits all" approach, groups as well as individuals grieve differently. A comprehensive bereavement service should have a continuum of care. The entry level could be a "warm line" that acutely bereaved individuals, especially those mourning victims of homicide and suicide, may feel "safe" calling to get a sense of what help is available, what they can expect, and what they may need. Brief readings to address "why" issues could be accessed on-line. Support groups should be of the "open" and "closed" types. The former can be joined anytime, permits flexible discussion, and does not follow a preset format such as the latter, which also closes entry once underway. Both peer and professionally led groups should be offered. Some consideration should be given to case-finding, outreach, and marketing. As most bereavement support is provided by natural systems, such as families and clergy, after "normal" deaths, few people may know where to turn when their needs are more complex. Both grief counseling and grief therapy should be provided as needed to address "uncomplicated" and "complicated" cases. Lastly, I'd consider organizing the service on the basis of a theoretical model of grief, particularly Worden's, so that there is a structured strategy and flow from one stage to the next (as appropriate)
Thanks Tony Salvatore! I agree with your "stepped-care" type of proposal. However I would include the possibility of having internet support option between phone line and other more advanced support options. It could improve risk assessment and provide useful information. Concerning Worden approach, it is a good initial framework to bereavement. However, some aspects are better addressed by new models (narrative, constructivist and dual model).
You are correct about adding an Internet-based support resource. In fact, there is anecdotal evidence that in the US the majority of those bereaved by a suicide turn initially or solely to suicide loss web sites, chat rooms, etc. for support. In some cases, local support groups have phased out because those they formerly served are using on-line options. Integrating web-based resources within a continuum of support options would enhance access, choice, and give users the opportunity to try alternative sources. I'll check out the new bereavement models that you mentioned. Regards!
The challenge I find is sustaining specialized groups requires more population than our area has. I'm looking at starting a new group in a rural community which will have to find someway to be "all things to all people." I'll probably shift focus based on the population participating at any given time.
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