Outreach includes bereavement support

Providers share tips for successful groups

A California hospice has found that its bereavement center and support groups have been successful in promoting hospice care and helping members of the public with grief after a loss.

In 2000, TrinityCare Hospice of Redondo Beach, CA, founded the Gathering Place in partnership with the Beach City Health District as a way to help everyone in the community who has experienced a loss, says Claire Towle, LCSW, director of the Gathering Place.

The drop-in center is open from 10 a.m. to 4 p.m. weekdays, although it's available for longer hours when needed. It has a welcoming room for people to gather and read bereavement information, and it has a room that is used by support groups, she says. "We have music and soft lights," Towle says. "There also is a child's playroom with art therapy activity, games, and toys."

The center is for loss and life transitions, but it's also marketed as a preventive care program, Towle notes. "It's our belief that if people receive the bereavement support they need, then we can reduce the number of long-term mental health problems related to long-term grief, anxiety, depression, substance use, social isolation, and anger," she explains.

The program has many anecdotal examples of its success, particularly among people who participate in the bereavement groups, Towle says. "We have a very positive image in the community, and people feel that hospice is doing a wonderful service for the community because of the bereavement center," she says. "We've received referrals from hospitals, churches, and word-of-mouth from people who were happy with our services."

A recent survey evaluation, developed at the center, was sent to support group participants. It elicited very positive comments about how rewarding the program was, Towle says.

The bereavement center and support groups also have helped TrinityCare Hospice recruit more volunteers among the people who first received grief counseling and support and then decided to volunteer to help others receiving hospice care, Towle says.

During 2006 and 2007, the nonprofit center served 757 clients with funding from the TrinityCare Hospice foundation, and public grants and donations, she says. Referrals come from the hospice, as well as from the community. "The hospice bereavement coordinator tells families about our program and gives them a packet of information," Towle says.

Maintain support groups

One of the reasons for the bereavement center's success is that the support groups are carefully maintained. Bereavement experts follow a curriculum, developed at the center, for the support groups and provide additional information and handouts, also developed at the center, to members.

"At the same time, we go with the flow of the needs of the group," Towle says. "We find a balance between having an agenda and providing information that's supportive."

Here are the center's strategies for maintaining successful support groups:

1. Provide a basic structure.

Support groups are offered in nine-week sessions instead of the drop-in type of support groups that continue indefinitely. "We also charge a small amount for adult support groups of $75 for a nine-week program and $10 for each drop-in group," Towle adds. "We started charging the fee two years ago as a donation that can be waived if someone cannot pay it." No one has complained or asked to have the fee waived, she adds.

The fee covers some of the nonprofit organization's costs, including materials costs, the salaries of two facilitators who run the support group, an average of one hour per participant in preparation time, and the time spent calling support group members in follow-up, Towle says. "A person's grief process is so important that it seems like an important investment for them that they want to pay for it," Towle says.

There is a skeletal curriculum that's individualized based on the support group members' needs and what kind of loss they've experienced, Towle says. At the first sessions, participants get to know one another. Everyone tells his or her story of who they are, she says. Typically, there are two group facilitators, who also will introduce themselves and tell their stories as a way to develop rapport. "They let members know this is a safe place," Towle says.

Facilitators hand out educational material and review the guidelines for participation, including confidentiality. Each meeting ends with an inspirational poem, meditation, some kind of relaxation, or candle lighting ceremony of some sort," Towle says. "By about the third meeting of each series, people ask if they can bring in their own inspirational saying, so they become invested in the process," she adds.

2. Discuss common responses to grief.

"The second meeting usually has a discussion about the common responses to grief," Towle says. "We talk about what people experience mentally, spiritually, behaviorally."

This meeting is very helpful to attendees because people can identify with these responses and realize that what they've experienced is normal, she says. "This facilitates interaction between members of the group, and they find common bonds," Towle adds.

3. Follow the model of tasks of grief.

The support groups do not follow the well-known Elisabeth Kubler Ross model of grief. Instead, they use the J. William Worden's Four Tasks of Grief Model, Towle says. Worden's theory has been published in several books:

  • Grief Counseling and Grief Therapy: A Handbook for the Mental Health Professional (3rd ed.), Springer Publishing; 2001.
  • Children and Grief: When a Parent Dies (paperback), Guilford Press; 2001.

"People go through certain tasks in their grief process," Towle says. "One task is to accept the reality of the loss, that this really happened, because there's a terrible disbelief when it happened." Subsequently, people will mourn and exhibit outward expressions of pain, she says.

Another task is to remember the person who died and begin to think of the person in terms other than the illness and facts of the death, Towle explains. "They begin to remember the good times and incorporate that loss into their lives, because their lives are different than they were," Towle says.

Moving forward is a task of grief, but it includes the understanding that throughout one's life there will be periods when the grief reappears with acute painfulness, she notes. "We provide some education on what they might experience, and we emphasize that grief is unique and each person will experience it in their own way and at their own time," Towle says.

4. Certain types of loss follow slightly different patterns.

One of the more successful support groups has been one for parents who've lost a baby shortly after birth or through a miscarriage. "We address some things that are unique to that experience," Towle says. "One thing that comes up is this is a grief that people don't understand; it's a disenfranchised grief."

People who've lost a baby before or right after the baby's birth feel they can't publicly mourn because people don't understand their loss, she adds. "They need a safe place where they can talk about this loss and what it means to them and to vent about the lack of understanding that people have for their experience," Towle says.

The support group teaches people that it's OK to mourn and provides a safe place for them to do that, she says. "We talk about their baby, and sometimes they'll bring in their photographs of the baby at birth and talk about their dreams and hopes and plans for this child," Towle says.

Having this type of support group is very helpful for parents who've experienced this loss because they're in a room with people who understand the loss, and it helps them feel less alone, Towle says.

"We talk about ways to memorialize the baby's birth, which often is the same day as the baby's death," she says. "In this group, people talk about their fears of a future pregnancy, fears that it could happen again."

Also, husbands and wives learn that they might be grieving differently, and it's OK if the wife is openly sad but the husband doesn't express his grief outwardly, Towle says. "They need to know that they can do it differently, and it's OK," she explains. "Sometimes that can pull people apart because the wife thinks her husband doesn't care or understand how sad she is."

5. Encourage group members to return.

"We call members midweek during the first four weeks and then every other week after that," Towle says. "We ask if they had anything to talk about that they were uncomfortable bringing up at the meeting. We give them personal attention and ask how the group session was for them."

These calls encourage members to return and show them that the bereavement center is there to support them even between their support group meetings, she says. "Many times I see someone on this first session in the support group, and their pain is so difficult," Towle says. "You can absorb the pain and sadness in the air."

By the ninth group session, there is a bond among the support group members and the atmosphere is lightened, she says. "The people in the group connect," Towle says. "Many people become best friends and continue to be friends for years and years."

Also, support group members will continue to meet after the nine weeks are over, getting together several times a year, she adds. "Their connection becomes more than their loss," Towle explains. "It started with the loss, but they become bonded and friends."

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