Grief Screening Tools for Hospital Social Workers — Victoria Hospice, BRAT, and PG-13

Why Screen at All?

Most people who lose a loved one in a hospital will grieve intensely and then, over months, gradually rebuild. They don't need a therapist — they need time, community, and practical support. But roughly 7-10% of bereaved individuals develop prolonged grief disorder (PGD), a condition formally recognized in the DSM-5-TR that involves persistent, debilitating grief symptoms extending well beyond the expected trajectory.

The problem for hospital social workers is timing. You're meeting families at the worst possible moment — minutes to hours after the death — and you have a narrow window to identify who among them is at elevated risk for complicated grief. You can't predict the future, but validated screening tools can help you flag the people who need closer follow-up and connect them with resources before they fall through the cracks.

The Victoria Hospice Bereavement Risk Assessment

Developed by the Victoria Hospice Society in British Columbia for hospice and palliative care, this framework can help clinicians consider bereavement risk factors. If adapting it for acute care, use the version and protocol approved by your institution.

The assessment covers:

• Pre-loss risk factors — the bereaved person's mental health history, previous losses, concurrent life stressors, social isolation, and the quality of their relationship with the deceased
• Circumstantial factors — whether the death was sudden or expected, traumatic or peaceful, and whether the bereaved person was present
• Post-loss coping indicators — early signs of adaptive or maladaptive coping, available social support, and practical resource access

Risk classifications and recommended follow-up depend on the version and local protocol. The framework can guide consideration of follow-up intensity, but it does not set a universal call schedule.

Its practical strength in the hospital setting is that much of the assessment can be completed from information already in the medical record — the patient's diagnosis trajectory, length of stay, family involvement during the hospitalization, and documented psychosocial history. You don't need to administer a formal questionnaire to a family in acute shock.

The BRAT (Bereavement Risk Assessment Tool)

The BRAT is a structured, clinician-administered tool used primarily in hospice and palliative care to evaluate the bereavement risk of family members and close caregivers before and after a patient's death. It shares conceptual ground with the Victoria Hospice model but uses a more formalized scoring system.

Key domains the BRAT evaluates:

• Nature of the relationship — dependency, conflict, ambivalence, or enmeshment with the deceased
• Mental health and coping history — previous psychiatric diagnoses, substance use, prior traumatic losses
• Social support network — presence or absence of family, friends, community, and spiritual connections
• Circumstances of the death — perceived quality of care, traumatic elements, unresolved guilt or regret
• Concurrent stressors — financial hardship, housing instability, caregiving responsibilities for others

The BRAT's main advantage is standardization — it gives clinical teams a shared language for bereavement risk that supports consistent handoffs between the acute care social worker, the palliative care team, and community-based bereavement services.

The PG-13 and PG-13-R

The PG-13-R is a symptom scale developed to map onto DSM-5-TR criteria for prolonged grief disorder (PGD); neither it nor the earlier PG-13 is an acute bedside risk tool. The DSM-5-TR diagnostic timing threshold is at least 12 months after the loss for adults and at least 6 months for children and adolescents, along with additional symptom, impairment, and cultural criteria.

For that reason, these measures are better suited to later clinical assessment than to an acute hospital encounter. At the bedside, focus on immediate safety, support, and follow-up planning; refer people with sustained severe distress for clinical assessment.

The PG-13-R assesses:

• Persistent yearning or longing for the deceased
• Intense emotional pain, sorrow, or pangs of grief
• Preoccupation with the deceased or the circumstances of the death
• Identity disruption — feeling that a part of oneself has died
• Difficulty engaging in ongoing life — avoidance, emotional numbness, inability to plan for the future

An elevated score can support a referral for clinical assessment, but a score alone does not establish a diagnosis or dictate treatment.

Practical Screening in the First Hours

You're not going to sit down with a newly bereaved spouse and administer a formal assessment instrument. That's not what bedside screening looks like. What you can do:

Observe and document. Watch for risk indicators that don't require questions: Is the bereaved person alone, with no visible support network? Did they make statements suggesting the death was their fault? Are they expressing intense anger at the medical team? Are they showing signs of dissociation — flat affect, inability to respond to questions, staring blankly?

Ask a few open-ended questions when the moment is right: "Do you have someone who can be with you tonight?" "Is there anything about this situation that feels particularly overwhelming?" "Have you experienced a loss like this before?"

Flag and document risk level in your chart note. Even a simple low/moderate/high classification in the EMR ensures that any follow-up social worker or community provider has a baseline.

Connect high-risk individuals proactively. Don't just hand them a phone number. With their permission, make the referral call while they're still in the hospital, or schedule a follow-up call for the next business day.

The Hospital Social Worker's Death Resource Kit includes a bedside bereavement risk screening worksheet adapted from the Victoria Hospice and BRAT frameworks — designed to be completed during the acute encounter without requiring a formal questionnaire administration. It captures the key risk domains in a format that supports both clinical decision-making and defensible documentation.