Breaking Bad News: A Case Study of Social Workers Communicating Bereavement and Distressing News in the Aftermath of Hamas Attack in Israel ()
1. Introduction
The act of conveying bereavement or distressing news is a core component of the responsibilities of health and mental health professions. Existing literature highlights that numerous physicians approach this task with apprehension, fear, and anxiety, often struggling to distance themselves from their own emotions in the process (Shaw et al., 2013) . Although the importance of breaking distressing news is now acknowledged, such conversations remain stressful for both the physician and the patient (Hilkert et al., 2016) . The manner in which bad news is delivered can profoundly impact patients’ ability to understand and adjust to their reality (Johnson & Panagioti, 2018) . Most of the studies conducted on delivering such reports focus on doctors in medical contexts, with limited research focusing on mental health teams operating within civilian populations during times of war and trauma (Berkey et al., 2018; Johnson & Panagioti, 2018) .
On October 7, 2023, Israel found itself immersed in a vortex of violence and despair following attacks by Hamas. The scale of devastation was staggering, with over 1400 lives lost, 240 individuals abducted, dozens missing, and countless others left traumatized (Codish et al., 2024) . Amidst this chaos, a crisis, less widely recognized but equally heart-wrenching, emerged: the daunting task of conveying tragic news to civilian families regarding the fate of their loved ones. This event stood out due to its unprecedented impact on the civilian population (Codish et al., 2024; Elyoseph et al., 2023) . The sheer number of casualties and abductions had enormous implications for the delivery of such distressing news, extending beyond military protocols and reaching into the civilian sector, posing an unparalleled challenge.
The daunting task of delivering devastating news to citizens fell upon a unique group of social workers in a particular city. The magnitude and complexity of the events make it challenging to envision how to deliver such bitter news. Despite training and simulations, adequately preparing for such situations remains a formidable task.
In Israel, traditionally, the military has been responsible for informing families about the loss or abduction of their loved ones, following a structured protocol. Delivering such news requires a unique skill set—balancing compassion, professionalism, and psychological insight (Ron & Shamai, 2011) . This type of news delivery has profound effects, impacting both the grieving families and the messengers (Freedman & Tuval Mashiach, 2018; Pikkel et al., 2017) .
In the absence of a well-functioning and established public infrastructure for delivering such tragic news, social workers were suddenly entrusted with this daunting responsibility. These individuals, lacking formal training in this specific area, were expected to inform families about the loss or abduction of their loved ones. This demand was extraordinary, especially considering that these social workers were grappling with the chaos themselves, facing potential threats to their own families, and harboring overarching concern for their children who might be serving in the military. Furthermore, this situation highlighted not only their individual struggles but also the shared or collective trauma experienced within their own families (Dekel et al., 2016; Levkovich & Swisa, 2022) . The constant fear and uncertainty surrounding their loved ones in the military compounded the emotional challenges they faced on the job.
This case study focuses on the experience, significance and impact of conveying distressing news by social workers, particularly in cases involving civilian deaths or captivity.
2. Methodology
This study employs a qualitative case study design. As such, it encompasses qualitative investigation and analysis of a single entity, aiming to capture its intricate nuances (Stake, 2012) . Within this study design, the emphasis lies on individual cases rather than the methods employed. The selection of this methodology is guided by the researcher’s intuition and understanding of the case, utilizing naturally occurring sources of knowledge, such as human subjects or observations of interactions within the physical environment (Stake, 2012) . It is crucial to note that case study research is not inherently comparative in nature. Its objective diverges from statistical inquiry, with no intent to produce universally applicable outcomes through the interpretive or social constructionist lens (Thomas, 2011) .
2.1. Procedure
The task of delivering devastating news to citizens following October 7, 2023 was assigned to a specialized group of social workers in a particular city in Israel. This medium-sized city in central Israel houses a welfare center, which includes a team of 20 social workers, a deputy director, and a director. Two Zoom interviews, each lasting two hours, were conducted with the director of the unit.
2.2. Ethical Considerations
This study received approval from the Ethics Committee of Oranim College (Authorization No. 1902024) and adhered to the principles outlined in the Declaration of Helsinki. The participant gave informed consent for their involvement in this study, having understood all aspects of their participation as explained in the consent form.
3. Findings
Social Workers Responding to Crisis: The Case of the Bad News Team in an Israeli City
The magnitude and complexity of the events made it challenging to deliver the bitter news. According to the participant in this study, despite training and simulations, adequately preparing for such situations remained a formidable task. Their duty required the formation of a team comprising of experienced and seasoned social workers, all of whom could never be fully prepared for the intensely difficult, painful, and intimate moments they would encounter when entering family homes. In such cases, preparation often falls short. To address this, the team leader was assigned a deputy to share the challenges and provide flexibility for rotations or substitutions as needed.
Two days after the outbreak of war, the team leader convened the members for an initial meeting to assess their readiness for the daunting task. Emotions ran high during the preparatory sessions. One social worker left in tears, deeply affected by the fact that both of his children were serving on the frontlines, while another expressed deep concern about her husband’s call-up for service. Other team members openly shared their personal concerns, adding to the tension and apprehension. Meanwhile, the team leader herself grappled with the demanding responsibility of delivering distressing news while juggling the responsibilities of having children both at home and in the military.
After the initial team meeting, adjustments were made to strengthen the team by incorporating personnel from additional units within the welfare division. There was a particular focus on recruiting social workers proficient in languages such as Russian and Amharic, given Israel’s diverse population. Two practical lectures on delivering distressing news were conducted to update the team’s skills and boost their confidence. Additionally, modifications were made to the initial notification procedure to better suit the situation. Instead of two social workers accompanied by a police officer, the delivery team now included two social workers accompanied by a military representative from the Home Front Command. This adjustment was made in recognition of the lasting impact of the announcement on the family.
The team leader created a meticulous weekly rotation schedule to ensure readiness for delivering news around the clock. With each incoming call, the team faced looming uncertainty of when their next message would arrive. The weight of delivering bad news loomed over the team daily, even on weekends. While maintaining a sense of normalcy for the affected families remained paramount, the team could not shake the constant apprehension that the next call might require them to deliver grim tidings. A week into the war, social workers assumed the responsibility of visiting families where a loved member was labeled as missing, their status as deceased or abducted still unknown. This added responsibility required the collection of essential information about each family, including the need for additional foreign language assistance, arrangements for the care for young children, and the presence of elderly or sick individuals in need of medical attention.
The initial delivery of such news posed immense challenges. A team consisting of two social workers wearing “social worker” badges on their clothing, along with a military representative, entered the family’s home to convey the distressing message that its child was listed as missing. The military personnel conveyed the initial news, while the social workers remained on hand to offer support and address the family’s needs.
Families reacted with varied emotional responses, all falling within the normal range. In retrospect, the social workers found comfort in knowing they had offered assistance and comfort during a trying time. Unfortunately, in some cases, another team later had to return to deliver the devastating news that the child had been identified as deceased. The toll on the team, both physical and emotional, became evident, prompting discussions on self-care and mutual support. It was recognized that team members needed an outlet to vent their feelings, ensuring that no one was left to grapple with their complex experiences alone. They shared coping strategies and personal sources of solace, such as spending time with friends and family, engaging in physical activity, visiting the beach, reading, and more.
4. Discussion
This case study examines the experiences and significance of social workers communicating distressing news, particularly in scenarios involving civilian fatalities or captivity. The participants in this case study described in detail the responsibility of delivering distressing news about civilian casualties or captivity, as it was assigned to a specially formed team of experienced social workers. Despite their training and simulations, they found it challenging to prepare fully for emotionally intense and intimate encounters in the homes of the affected families. This comprehensive approach underscored the complexity of their tasks and the multifaceted support required to perform them effectively (Berkey et al., 2018; Hilkert et al., 2016; Johnson & Panagioti, 2018; Shaw et al., 2013) . In situations requiring the delivery of adverse or challenging news, particularly under circumstances where the news is unexpected (e.g., in emergency settings), where there is insufficient time for mental health professionals to prepare adequately, or when the details of the news are ambiguous due to uncertain diagnoses or prognoses, the demands on those involved are significantly heightened. This dynamic has underscored the detrimental effects such conditions can have on the individuals involved, including elevated stress levels and an increased risk of burnout (Johnson & Panagioti, 2018; Shaw et al., 2013) .
The concept of “Shared Traumatic Reality” (STR) refers to mental health professionals who, while living and working in high-risk areas, share the same traumatic experiences as those they help (Dekel et al., 2016; Levkovich et al., 2023; Nuttman-Shwartz, 2023) . Research indicates that these professionals frequently experience emotional distress, feeling threatened and vulnerable, with emotions including sorrow, fear, anxiety, and helplessness (Baum, 2010; Cohen & Sherman, 2014; Freedman & Tuval Mashiach, 2018; Pruginin et al., 2017) . Social workers often grapple with loyalty conflicts, torn between their responsibilities to clients and the need to ensure their own and their families’ safety (Lavi et al., 2017; Pruginin et al., 2017) . Studies show that this dual role may cause disturbing thoughts, concentration issues, decreased availability to clients and families, heightened guilt, and lowered professional self-esteem (Baum, 2010; Dekel et al., 2016, Lavi et al., 2017; Tosone et al., 2015) .
To manage heightened personal anxieties due to the war (Levi-Belz et al., 2024a; Levi-Belz et al., 2024b) which affected team members with relatives directly involved, the team structure was made flexible, incorporating a deputy leader and a rotation option. Additional training was provided, and the notification process was enhanced by involving military representatives, acknowledging the significant impact of their communications. The team maintained a rotation schedule for constant readiness and addressed needs such as language barriers and childcare. Prioritizing emotional support for families (Feingold et al., 2024) , the team also focused on mutual support and self-care practices (Elyoseph et al., 2023) for the social workers, highlighting the complexity and the multifaceted support needed for their effective performance (Elyoseph et al., 2023; Nuttman-Shwartz, 2023) .
5. Conclusion
In conclusion, this study underscores the critical need for comprehensive training programs that prepare mental health and medical professionals to deliver distressing news effectively (Elyoseph et al., 2023) . Our findings reveal a significant gap in civilian systems for communicating such news, drawing attention to the need for specialized training similar to military protocols. By cultivating a cadre of professionals, either full-time or embedded within welfare departments or psychological units, who are well-prepared to manage these sensitive situations, we can enhance the effectiveness of news delivery and reduce the risk of secondary trauma. This study confirms the essential role of proper training and ongoing support in fostering a compassionate and effective approach to handling bereavement and distressing news during crises.
6. Recommendations
Establishing a supportive environment for health professional learners to engage in discussions about difficult family interactions, such as breaking bad news, can enhance their competency in addressing psychosocial needs in a patient-centered manner and improve team communication (Babiker et al., 2014; Seoane et al., 2012; Sweeney et al., 2015) . Such robust discussions contribute to a deeper understanding of the diverse roles within the healthcare team, recognizing that no single practitioner has the complete set of skills, knowledge, or attitudes necessary to meet all care needs. Furthermore, literature on breaking bad news underscores the importance of providing opportunities for healthcare learners to develop clinical decision-making, critical thinking, and communication skills essential for managing complex, emotionally charged situations (Sweeney et al., 2015) . For instance, healthcare simulation has proven beneficial in fostering self-reflection, self-awareness, and teamwork, enabling learners to apply new knowledge practically in a controlled, risk-free setting. These elements are crucial for the effective support of families and the interprofessional team during challenging encounters (Setubal et al., 2018) .
7. Limitations
This is a case study which examined specific research and does not allow for generalizations about populations in other locations that have faced similar emergency situations. Additionally, it should be noted that this is a dynamic and evolving situation; therefore, it is recommended that further examination be conducted more broadly at different points in time. It is also advisable to assess the impact of intervention programs on the social worker team during these examinations.
Ethics Approval and Consent to Participate
The study was approved by the Ethics Committee of Oranim College (Authorization No. 1902024) and was conducted in accordance with the Declaration of Helsinki.
Consent to Participate
The participant has given informed consent for their involvement in this study, having understood all aspects of their participation as explained in the consent form.
Availability of Data and Materials
The datasets used and/or analysed in the current study can be obtained from the corresponding author upon reasonable request.