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From September 2012 to April 2013, I had the pleasure of completing an 400 hour field placement with Durham Hospice (now VON Durham Hospice). During the first 200 hours (my first semester), I completed the Fundamentals of Hospice Palliative Care Course, learned how to perform psychosocial assessments and assisted in the facilitation of a Day Hospice group.
My second semester and final 200 hours, I completed an 8-week Bereavement Volunteer Peer Support Program that focused on the fundamentals of providing individual and group peer support to grieving individuals. That’s where I learned about this tool, the Bereavement Risk Assessment Tool (BRAT).
The BRAT was developed by Victoria Hospice Society to help “communicate personal, interpersonal and situational factors that may place a caregiver or family member at greater risk for a significantly negative bereavement experience” (Victoria Hospice Society, n.d.)
The version of the BRAT I worked with is the 2008 version, though the 2013 manual is available for purchase on the Victoria Hospice website.
Bereavement Risk Assessment Tool (BRAT) Items
The BRAT is organized into 11 domains for a total of 40 items. Each is scored on a yes/no basis and a risk level (unmitigated and mitigated.) The “unmitigated risk” level is the raw score from the first 10 domains, while the “mitigated risk level” takes into account the 11th domain. The domains are listed below, though the items themselves are not, out of respect for the author’s copyright:
- Mental Health
- Concurrent Stressors
- Previous Bereavements
- Supports & Relationships
- Children & Youth
- Circumstances Involving the Patient, the Care or the Death
- Protective Factors Supporting Positive Bereavement Outcomes
Scoring the Bereavement Risk Assessment Tool
The BRAT is scored using an Excel sheet that automatically calculates the correct score and prepares the document for printing. Documentation information includes the date, the assessor and client’s names, an ID number (e.g. case/file number) and the name of the deceased.
Five Levels of Risk
- Risk Level 1: No Known Risk
- Risk Level 2: Minimal Risk
- Risk Level 3: Low Risk
- Risk Level 4: Moderate Risk
- Risk Level 5: High Risk
Research Support for the Bereavement Risk Assessment Tool
The BRAT has received some, though very minimal, research exploration. Rose et. al. (2011) explored the inter-rater reliability of the BRAT and found it adequate (inter-class correlation of 0.68.) Qualitative responses indicated it was a useful tool for assessment of bereavement risk.
The lack of other published work significantly limits the usability of these tool in a research environment. Other reviews (e.g. this presentation by Bill Palmer) fail to identify the BRAT in a list of bereavement assessment tools which suggests it may not be well-known outside of the Canadian Hospice environment.
Other Bereavement Risk Assessment Tools
These tool recommendations come from Bill Palmer’s presentation:
- Adult Attitude to Grief Scale (AAG)
- Core Bereavement Items (CBI)
- Grief Evaluation Measure (GEM)
- Inventory of Traumatic Grief (ITG)
- Texas Revised Inventory of Grief (TRIG)
Rose, C., Wainwright, W., Downing, M., & Lesperance, M. (2011). Inter-rater reliability of the Bereavement Risk Assessment Tool. Palliative & Supportive Care, 9(2), 153-164. doi:10.1017/S1478951511000022
Victoria Hospice Society. (n.d.) “Clinical Tools | Victoria Hospice Society” Retrieved on October 17, 2016 from http://www.victoriahospice.org/health-professionals/clinical-tools