Texas Children's Hospital and Bo's Place Offer
A Safe Place for Children to Heal

It is an old clapboard house on a side street in the Museum District. Inside it is evident that the house is being used: everywhere there are children's pictures, chairs in all kinds of conditions, over-sized pillows, books, boxes filled with donations.

Bandaging broken hearts: "It's about making things normal again, about putting lives back together again."

The large quilts that hang on the walls have clearly been made by children. The individual squares - some made with paint, others with stitchery - carry simple messages: "I Love You," "I Miss You," "Love is Always," "In Memory of My Dad."

The house is called Bo's Place. It is a place for children to grieve and to share their loss of a parent or sibling with others who have experienced a terrible loss. But Bo's Place is not a sad place; the tone set by the staff and the many volunteers is one of hope and healing.

"Loss is very individual, and it's a very complex feeling in children," says Karen Pennebaker, executive director of Bo's Place. "After the death of a sibling or parent, a child can feel very isolated, as though he was the only one in the world this could happen to. Children are still learning how to communicate their feelings, so they need help."

In the early evening at Bo's Place, families come together for a pot luck supper. Following this, the children go off in age-appropriate groups, and their parents go to a separate room for their group session. In the children's grief support group, trained volunteers and professionals guide the children through processes of talking about their grief, listening to others and sharing each others' experiences of grief and loss.

"It's a safe place and time to share feelings," says Pennebaker, a licensed social worker who has been at Bo's Place since 1995. "But it's very important to know that this process is not about death and dying. It's about making things normal again, about putting lives back together again."

Currently, 233 children and their families are attending grief support groups at Bo's Place.

The staff and volunteer group leaders ask families to wait two months after the loss of their loved one before beginning the grief support program at Bo's Place. Typically, children and their families attend the support meetings for about a year and one-half; some have stayed for three years, others leave after three months.

Texas Children's Hospital is referring children and families to Bo's Place.

Dr. David Poplack is director of the Texas Children's Cancer Center and head of the hematology service. "It's wonderful work being done at Bo's Place," he says. "We have found that there's a tremendous need for this kind of service. It fills a gap in the grieving process and offers support to a kid who's lost a sibling." Dr. Poplack and other professionals interviewed for this story worry about the siblings of an ill child being "forgotten in the process." The Child Life program at Texas Children's tries very hard to help siblings through the difficult period. Child Life workers - who typically work with the young patients to ease their fears of surgery and other aspects of their stay in the hospital - work with siblings of patients, especially when death is impending. Adults may not fully understand the way a child grieves - typically in "spurts" - and may think, `Oh they're OK.'

"There's no formula or protocol for grief," says Dr. Ernest Fruge, director of psycho-social service at Texas Children's. "Our partnering with Bo's Place helps to ensure that the parents are empathic about their children's reactions to loss, and the program reinforces opportunities for children to express their grief and their thoughts." Dr. Fruge sees the evening groups at Bo's Place as a completion of the process which began with caring for the patient and closes with healing the family.

"We asked ourselves, `How do you approach a child in grief?'" says Dana Nicholson, director of nursing services at Texas Children's. "One of the things that we have wanted to address is the needs through the whole continuum. We did not offer services to a family after a child's death, but the siblings and parents are in terrible grief. We discovered Bo's Place and the fabulous program already in place, so we asked to partner with them to help meet the needs of these families," says Nicholson.

Texas Children's families have two evenings a month at Bo's Place; currently, there are two parent groups and five groups for children - groups for 5-7-year-olds, 8-9-year-olds, 10-12-year-olds, and two teen groups. With the younger children, the counselors use art frequently, and puppets. Even with teens, emotions can sometimes run too deep for words.

Kristie Holubec, a licensed social worker at Texas Children's, has volunteered at Bo's Place for a year. She encourages other TCH employees to volunteer as group facilitators. The training for the volunteers is intense and fairly lengthy - 30 hours. Prospective volunteers will, hopefully, gain insights about themselves. The essential question for the volunteers is: Am I healthy enough to help someone else with their grief?

"Sometimes the counselors know the families," says Holubec. "They have seen them at the hospital, or even worked in the unit where the child was. Of course a family does not want to return to the hospital after their child has died; that would just be too difficult. So Bo's Place offers a new place to go."

"In many cases, the family also experiences the loss of the TCH staff who cared for their child over a long period," says Sean Morgan, clinical social worker at the TCH Cancer Center. "And of course the staff feels very close to the family. So it is more than just a referral to Bo's Place. There is a continuity with the family and the treatment shifts to helping them heal."

Using art to express their feelings: "My dad and I were popcorn buddies."

Professionals who work in grief counseling all agree that it's best to be honest and forthright with the parents and siblings of the sick child. "We prepare the siblings before they go into a hospital room or unit, tell them about the machinery they will see, the hospital smells and - most importantly - that their brother or sister is very ill," says Nicholson. "We want to talk to them about their feelings. Parents need to tell the other children what is happening, because it can be frightening to not know."

In a large hospital like Texas Children's, located in a very cosmopolitan city and with a large international patient census, understanding cultural nuances is a must. "Every culture has grief," says Nicholson. "Sometimes we are not sure what to expect, but we want to be knowledgeable and respectful of different beliefs."

While many families have benefited from their evenings at Bo's Place, it may not be for some. "This kind of group sharing may not be right for all," says Morgan.

The lesson that Bo's Place teaches us is that families - and especially the children in those families - need a period of grieving in order to help make things whole again after the most terrible thing, the death of a child.

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©2006 Texas Medical Center

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