Child Care in Practice

Vol. 12, No. 1, January 2006, pp. 53
/61

Postvention: A Community-based
Family Support Initiative and Model
of Responding to Tragic Events,
Including Suicide
Susan Forde & Carmel Devaney

This paper provides an account of the design, development and implementation of a

postvention model of responding to the needs of families within a community following
the aftermath of a tragic event, including suicide. This model was developed for a specific
disadvantaged urban community. The paper includes the context of the need for such an
undertaking and discussion on the family support theories that underpin its develop-
ment. A retrospective critique of the initiative and subsequent model is provided,
including the inherent strengths and limitations and a description of further family
support practice developments.

Introduction
The purpose of this paper is to retrospectively examine a family support practice
initiative, both in its execution and the influence it has had on practice as a result.
The aim of the initiative was to devise, develop and adapt a family support model, in
line with best practice, of responding to the needs of families within the community
following the aftermath of a tragic event, including suicide. The geographical context
of the task was a community located on the east side of Galway city that has
experienced a high rate of suicide and other tragic events. The community is served
by two Health Service Executive, Western Area Family Support projects, namely a
Neighborhood Youth Project and a Springboard Family Support Service. The
Neighborhood Youth Project is a community-based adolescent and family support
project, while the Springboard project concentrates on providing support to young
children and parents more specifically. However, while both projects fall within the
domain of family support, they have separate aims and objectives but share common

Susan Forde is a Children Act Services Manager and Carmel Devaney is Springboard Project Leader.
Correspondence to: Susan Forde, c/o Pat Dolan, National University of Ireland, Galway, Department of Political
Science and Sociology, Block T, Distillery Road, Galway, Ireland. Email: Susan.Forde@mailn.hse.ie

ISSN 1357-5279 print/1476-489X online/06/010053-09 # 2006 The Child Care in Practice Group
DOI: 10.1080/13575270500526303
54 S. Forde & C. Devaney
issues, concerns and needs. Similarly, both projects operate from a preventative
strengths-based perspective.
The rationale for the development of this family support model included the
following:
. As meeting the needs of families following suicide is an issue common to both
projects, and both staff teams had specific questions on best practice in responding
to families in such difficult circumstances, it was deemed appropriate to jointly
develop a model.
. Recognition that suicide and tragic events occur in all communities.
. There were no previous written procedures, guidelines or protocols for commu-
nity-based family support services in responding to tragic events and suicide.

The initiative set out to devise a model that would have a broad remit in terms of the
categories of persons it could be applied to. The model is intended to be transferable
for use in situations where adults and young people have died both within the
immediate and extended family and within the community itself. The initiative was
instigated, devised and implemented in partnership between the project leaders of
both projects. This paper will firstly situate the initiative within the theoretical
frameworks that underpin family support. Secondly, the planning, implementation
and outcomes of the initiative will be discussed, including future opportunities,
followed finally by an analysis of its strengths and limitations.

Theoretical Framework
While typically, although not exclusively, family support focuses on prevention, it
also has a support function in terms of crisis and tragic life events. The initiative falls
into this category; however, it still maintains a clear support function with the key
preventative strategy of ensuring social support for families experiencing tragedy,
with the long-term goal of preventing stagnation by ensuring that families are linking
with and aware of support services if required for the future.
The model is heavily influenced by the guiding principles that underpin the
practice of family support. These principles are evident within the model, in terms of
listening to service users, inter-agency working, provision of needs-led services and
focusing on prevention and early intervention (Brady, Dolan, & Canavan, 2004;
Henderson & Bradford, 1999; McKeown, 2000; McKeown, Clarke, & Little, 2003).
Perhaps the outcome of the initiative creates more specific good practice principles,
as they refer to the details of guiding how family support services are provided in
tragic circumstances (Brady et al., 2004). In this instance, it can be argued that the
principles of family support as applied to this initiative have led to the development
of a family support model of good practice in dealing with tragic events. Therefore,
the principles of family support equate to standards of best practice and quality.
The principles of family support are firmly embedded in the ecological perspective
that recognises the family is a system within itself, where the care, protection and
 Child Care in Practice 55
development of children, among other functions, are facilitated. The ecological
perspective is referred to by Bronfenbrenner (1979) as a set of nested systems, which
he refers to as the microsystem, mesosystem, exosystem and macrosystem. One of the
main thrusts of the ecological approach is that families do not exist in isolation and
they are both effected by and influenced by the surrounding environment. Essentially,
the ecological perspective proposes that there is an interdependent relationship
between the individual and the environment (Bronfenbrenner, 1979; Garbarino,
1981; Jack, 2000; Kemp, Whittaker, & Tracey, 1997).
In terms of tragic life events, the microsystem is ultimately affected and devastated
by the event. However, it also has support systems and relationships within it that will
support coping. Similarly, the mesosystem is also an available support and, in terms
of this initiative, families known to family support services prior to the crisis have
already incorporated the service into their mesosystem.
Previously, reference was made to social support. Essentially, it equips one with the
provisions to deal with stress and cope in life (Cohen & Wills, 1985). Research
suggests that social support can act as a stress-buffering factor by providing help or
support at moments of particular need (Ghate & Hazel, 2002, p. 17). Social support
incorporates the provision of instrumental and emotional assistance at times of need,
so that long-term stress is prevented or does not arise easily (Barrera, 1986; Cohen &
Wills, 1985; Lazarus & Folkman, 1984; Thompson, 1995). A distinction should be
made between formal and informal support. Informal support arises out of a person’s
own network of family and friends, whereas formal support is provided by paid
persons or services outside of this network (Ghate & Hazel, 2002). Natural informal
support is crucial and should not be undervalued in favour of formal support,
particularly during times of crisis. Cutrona (2002, p. 120) argues that a support
worker’s ‘‘first priority should be facilitating the flow of support within existing social
networks of family and friends, rather than trying to ‘graft on’ new sources of
support’’. Similarly, Cutrona (2002) also emphasises that emotional support can be
provided to members of the natural network to sustain them in their efforts to
support other members of the network.
Another crucial consideration in the provision of social support is that of timing
(Dolan & Holt, 2002). Likewise, different kinds of support are more beneficial at
different stages of the crisis. Cutrona (2000) and Weiss (1976) describe the stages of
crisis and the requirements from support providers. Initially, on learning of a crisis or
tragedy, a person may simply need assistance in managing the crisis (e.g. calling for
an ambulance, gathering information about what happened, making funeral
arrangements, etc.). Essentially, Weiss (1976) contends that a crisis can end in either
of two ways: the person makes a full recovery, or ‘‘persisting disruption’’ occurs (the
person dies). In the latter case the family enters a period of ‘‘transition’’, and Weiss
suggests that three different kinds of support providers are important. The first is
the ‘‘expert’’, who is a person with authority who has studied the problem. Generally,
the family support worker falls into this category. It should be noted that while the
worker may not necessarily have all the expertise required in terms of counselling,
psychiatric care, and so on, the expertise is in the ability to access the right service for
56 S. Forde & C. Devaney
the individual at the right time and to support them in using such services. One of
the key roles of a family support worker is to access appropriate services for young
people and families. This may include making referrals on behalf of the family,
coordinating an interagency response, providing assistance to attend appointments,
among other roles.
A second type of support is the ‘‘veteran’’, who is a person who has already
been through this experience and has learned to cope. The third type is that of ‘‘fellow
participants’’, other people who are experiencing the same life transition. The
initiative generally incorporates the first category of support providers, while the
latter two may be more appropriate forms of support in terms of meeting the family’s
medium-term to long-term support needs. Cutrona (2000, p. 111) argues that it is
important to ensure ‘‘optimal matching’’ between stress and social support. That is
the provision of the right type of support for the particular presenting crisis. She
argues that nurturant support and instrumental support are most beneficial in
different kings of stressful life events. In situations where the crisis can be controlled,
instrumental support is favourable; however, in situations where the crisis is not
controllable, nurturant support is best.
Another concern in terms of the provision of family support is that people who
may need help or perceive they need help do not ask for help from available services
(Broadhurst, 2003). There may be countless reasons for this but what is important is
that family support services must strive to ensure accessibility and amiable services.
It is also crucial to bear in mind the issue or reciprocity. Williams (1995) points out
that receiving support, no matter how warranted, creates an emotional cost for the
receiver and damages their ‘‘self-image as independent self-sustaining persons’’.
Evidence propounds that while receiving support is beneficial, the experience of
reciprocity is most strongly associated with psychological well-being (Cutrona, 2000).
By the same token, Cutrona also finds that people do not uncritically accept offers of
support. In general, people tend to be umbrageous as to why support is being offered
to them. However, if they perceive it as genuine concern, the likelihood of acceptance
is greater. Additionally, McKeown (2000) contends that family support must be
responsive, accessible and must be available to families when they need it.
This practice initiative is firmly embedded in the guiding principles of family
support and the ecological perspective. Similarly, the concepts of social networks and
social support that are inherent in the practice of family support are also evident and
they are viewed as protective mechanisms that serve to strengthen individuals and
families. The notion of reciprocity is also discussed and the importance of its
inclusion in the provision of family support.

The Planning, Implementation and Outcomes of the Initiative

The first undertaking was the establishment of an advisory group whose purpose was
to oversee the initiative, to advise on how best to achieve the aim and to elicit their
expertise in the area. Membership included statutory and voluntary family support
personnel and community representation. The advisory group approved the rationale
 Child Care in Practice 57
for the initiative as discussed previously. The advisory group continued to meet over
the course of the initiative and officially approved the resulting model prior to it
being finalised and presented to project staff and management.
Three methodologies were chosen in order to gather relevant, appropriate and
expert knowledge in order to complete the initiative and create the model:
1. A literature review was conducted, including consultation with Health Service
Executive, Western Area staff and others who have expertise in the areas of mental
health, community health, child and adolescent psychiatry, education and service
users. An outcome of this exercise included the compilation of a reading and
resource pack.
2. A focus group was conducted comprising persons with expertise across a wide
range of disciplines and agencies, and rich qualitative data were gathered as a
result of this process. Questions asked of the focus group centred on their
opinions of what is best practice when responding to the needs of a family
following a tragic event. The discussion was contextualised in terms of families
known and unknown to family support services prior to the tragedy.
3. In-depth semi-structured interviews were conducted with service users, including
parents and adolescents. This process enabled experiential information to be
obtained as some of the service users had experienced tragedy, while others had
excellent working relations with the family support services and were able to give
their opinions based on their experience of using the service.

The information gathered from the literature review, the focus group and the
interviews was collated and informed the design of ‘‘a family support model of
response to tragic events in a community setting’’. This family support model
provides systematic guidance for family support staff in responding to families both
known and unknown to the service. It includes guidelines for staff in terms of the
short-term, medium-term and long-term actions that may be required to meet the
families’ needs. It is also important to note that, prior to the adoption of the model
by management and staff, a draft model was presented to the service users who were
involved in the interviews, for their consent and approval.
The implications which this initiative and the resulting model have had on practice
have been far-reaching. Unfortunately, since the adoption of the model, tragic life
events have occurred in the community. Generally, family support staff have reported
feeling more comfortable in their approach towards offering support to these
families, as the model clearly delineates a pathway. The model informs a practical
response for guiding project staff in their role. However, caution must be exercised in
using this model as it does not compensate for common-sense and sound
professional judgement. Another outcome of this initiative is that it created a forum
for discussion and placed the management of tragedy on the agenda, both for
professionals and for the community in general. It also raised the issue of a
community approach to the prevention of tragedy, including suicide, which
subsequently resulted in two further practice initiatives being developed.
58 S. Forde & C. Devaney
The first was the development of a help card. A multi-agency and multi-
disciplinary approach was taken in devising the card and included representatives
from the statutory Health Services, voluntary organisations and the local community.
The card was sponsored by the Health Services Executive, Western Area and was
hand-delivered to every household and amenity in the community. The second
outcome was the facilitation of an information night for parents concerned by
suicide. A video was made for this event, the purpose of which was to generate
discussion and, more importantly, to impart valuable information.

Strengths and Limitations of the Initiative, Including Future Opportunities

Retrospectively, an analysis of the initiative and model raises both strengths and
limitations in both the execution of the task and in the resulting model.

Strengths

. The initiative and model is firmly embedded in family support theory.

Particularly, in terms of family support principles, the ecological perspective,
social support and the concept of reciprocity.
. The model has two categories. The first refers to families that are known to
family support services prior to the tragedy occurring, while the second category
are families that are unknown to services prior to the tragedy. This categorisation
is based on theoretical evidence and best practice. It is not appropriate for family
support workers to enter a family system for the first time, particularly at a time
of tragedy, without invitation and agreement from the family. Therefore, in terms
of unknown families, the model recommends that the family support worker
should refrain from engaging in the family system directly but instead should
make a link with a person who is already involved in the family’s support
network (Cutrona, 2002).
. The model recognises the importance of a family’s informal social network and
seeks to consolidate this rather than replace it with formal support networks.
. Engrained in the model is the importance of considering timing when offering
any type of family support.
. The model is mindful of the emotional cost of receiving support and tries to
minimise this by ensuring that any support offered comes as a result of genuine
concern. The theory of reciprocity argues that, if this is the case, the likelihood of
acceptance is greater.
. In keeping with the ecological perspective, the model recognises the inter-
dependency and inter-connectedness of the family system and recommends that
the support needs of the extended family, friends, neighbours and the
community in general be considered.
. The model emphasises that respect for the wishes of the family are paramount.
 Child Care in Practice 59
. The initiative was as a result of tragedies and a genuine concern and desire to
provide a family support response that was in line with best practice.
. Throughout, the initiative and model was quality assured and several systems
were put in place to ensure quality; for example, the advisory committee,
presentation of a draft model to service users, a robust methodology was used as
more than once source of information gathering.
. The model was developed in consultation with service users and had a multi-
agency and multi-disciplinary focus.
. The framework used to devise the model is easily transferable for use by other
family support services in other communities.
. Similarly, the model is dynamic and can be adapted as required in line with
research outcomes and best practice initiatives.
. The initiative was a catalyst for other developments, including the reading and
resource pack, the help card and the information support evening for parents
concerned by suicide, including the video.

Limitations

. The task did not consider the level of need of a family prior to a tragedy; for
example, families in level 1 and level 4 of the Hardiker model could have very
different support needs and experience of services, and as a result require different
approaches and interventions. The model is perhaps too universal in its
orientation.
. The model does not consider the breadth of responsibility that a family support
service may acquire if families who experience tragedy do not have functional
informal support networks.
. The model assumes that family support staff have a basic understanding of
bereavement and loss.
. If this exercise were to be repeated, more data from family support ground floor
staff should be included. Perhaps it might be appropriate to engage staff in focus
groups or interviews.

Conclusion
In summary, a collaborative initiative in partnership with service users, professionals
and the community facilitated the design and development of this model of
responding to young people and families support needs following a tragic event,
including suicide. Throughout the process, best practice and a solid theoretical
framework was evident. The initiative itself, and the resulting model, is firmly
embedded in the ecological perspective. Adopting an ecological approach provides an
awareness of the overall context of the family, community and environment at large,
including their interdependency. Furthermore, the initiative and the model reflects
key family support principles, including a strengths-based perspective that is mindful
60 S. Forde & C. Devaney
of resilience as a characteristic of many young people and families, it strengthens
informal support networks and provides a needs-led service that strives for the
minimum intervention required (Canavan, Dolan, & Pinkerton, 2006). While the
initiative focused on the provision of support after tragic events, it acted as a catalyst
and placed the issue of preventing the occurrence of such life events onto the agenda
both among professionals and within the community. Ongoing development in the
areas of prevention, intervention and postvention in respect of suicide and tragic
events are necessary to further enhance the delivery of family support services.

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