Introduction Understanding the ways parents cope with grief prebereavement is as important in the bereavement care pathway as how they may cope after death. Within a framework of practice development the authors identified, modified and piloted the Adult Attitude to Grief Scale (AAG) (Machin 2001) to assess how families were coping prebereavement.

Aims The aim of using the assessment tool was to enable parents to tell their story and to recognise and further understand their grief experience prebereavement; to identify what kind of support might be offered so that resources could be targeted more appropriately.

Method

• ▶ Literature review

• ▶ Survey of children's hospices

• ▶ Reflective diaries

• ▶ Action learning groups within a framework of practice development to identify and modify the AAG scale

• ▶ An initial pilot with 40 families

• ▶ Evaluation to determine the ongoing integration of the tool in practice.

Results The assessment revealed a therapeutic value that enabled individuals to tell their story and parents reported a sense of being understood. Findings indicated those individuals who required additional support which helped in the management and provision of services.

Discussion The pilot revealed two important dimensions:

• ▶ The impact on the organisation in relation to service procedures – this included implementing the tool in practice as well as the professional development of staff.

• ▶ The assessment process encouraged a stronger therapeutic engagement with parents.

Conclusion The modified AAG scale when used with parents can add significant information in understanding their grief experience prebereavement. The assessment alongside clinical judgement has enabled the identification of possible vulnerability as well as resilience, which can enable healthcare professionals to support families appropriately and target resources effectively.