PBC Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: A bereavement coordinator is developing a safe-messaging protocol for staff who contact bereaved families by phone. Which element is MOST critical to include?
- Scripts for encouraging families to return to normal activities quickly
- Guidance on recognizing and responding to expressions of suicidal ideation (Correct answer)
- Instructions for scheduling autopsy result delivery
- Templates for anniversary card mailings
Correct answer: Guidance on recognizing and responding to expressions of suicidal ideation
Safe-messaging protocols must equip staff to recognize and respond to suicidal ideation, as bereaved parents have elevated suicide risk.
Question 2: Which population within perinatal bereavement has been specifically identified in research as having ELEVATED suicide risk compared to the general population?
- Fathers of preterm infants who survived more than 28 days
- Mothers within the first year following stillbirth or neonatal death (Correct answer)
- Grandparents of infants who died from congenital anomalies
- Siblings of infants who died in the NICU
Correct answer: Mothers within the first year following stillbirth or neonatal death
Research documents that mothers are at significantly elevated suicide risk, particularly in the first year following stillbirth or neonatal death.
Question 3: A bereaved mother reports intrusive flashbacks of her labor and delivery, hypervigilance, and avoidance of the hospital where her baby died, six weeks after the event. These symptoms are MOST consistent with:
- Prolonged grief disorder
- Post-traumatic stress disorder (PTSD) (Correct answer)
- Normal acute grief
- Major depressive disorder
Correct answer: Post-traumatic stress disorder (PTSD)
Intrusive re-experiencing, hypervigilance, and avoidance are cardinal PTSD symptoms, which commonly co-occur with grief after traumatic perinatal loss.
Question 4: When assessing risk in a family from a culture that practices private, internalized mourning, the clinician should:
- Use standard Western grief screening tools without modification
- Interpret silence and stoicism as low-risk indicators
- Explore culturally specific expressions of distress and consult cultural liaisons as needed (Correct answer)
- Defer assessment until the family voluntarily seeks services
Correct answer: Explore culturally specific expressions of distress and consult cultural liaisons as needed
Cultural competence requires exploring how distress is expressed within a family's cultural framework rather than applying Western norms.
Question 5: A quality improvement review finds that 40% of bereaved families received no follow-up contact after hospital discharge. The MOST effective systemic mitigation would be to:
- Require families to call the hospital if they need help
- Implement a structured bereavement outreach protocol with designated follow-up timelines (Correct answer)
- Add bereavement pamphlets to the discharge packet
- Train NICU nurses to provide bereavement counseling without additional resources
Correct answer: Implement a structured bereavement outreach protocol with designated follow-up timelines
A structured, proactive outreach protocol ensures consistent contact rather than relying on families in crisis to self-initiate.
Question 6: A parent who experienced a 20-week pregnancy loss asks if what she is feeling 'even counts' as real grief. The clinician's response should be guided by which principle?
- Gestational age determines the clinical significance of grief
- Disenfranchised grief from early losses can be equally intense and warrants the same risk assessment (Correct answer)
- Emotional responses before viability are typically resolved within two weeks
- Legal definitions of fetal death should frame the clinical conversation
Correct answer: Disenfranchised grief from early losses can be equally intense and warrants the same risk assessment
Disenfranchised grief—grief that is not socially recognized—can be as intense as any other loss and requires the same thorough risk assessment.
Question 7: Which of the following is an evidence-based protective factor that REDUCES risk of complicated grief following perinatal loss?
- Rapid return to employment within two weeks
- Access to a supportive partner and broader social network (Correct answer)
- Absence of prior mental health treatment history
- Choosing not to see or hold the deceased infant
Correct answer: Access to a supportive partner and broader social network
Strong social support, particularly from a partner, is consistently identified as a primary protective factor that buffers against complicated grief.
PBC Risk Assessment & Mitigation 3
A bereavement coordinator is developing a safe-messaging protocol for staff who contact bereaved families by phone.
Which element is MOST critical to include?