Blue Ridge Hospice has pioneered a groundbreaking approach to bereavement support that merges therapeutic principles with the engaging world of tabletop role-playing games. This innovative program represents a significant shift in how we approach grief support for young people, combining clinical expertise with creative engagement strategies.
The “Adventures in Grief” Program: Origins and Development
The “Adventures in Grief” program emerged from Blue Ridge Hospice as a novel way to address the unique bereavement needs of adolescents and young adults. This Dungeons and Dragons-style tabletop role-playing game was specifically designed as a therapeutic tool to support young people processing grief.
The program was developed by Tina Thomas, a social worker at Blue Ridge Hospice, who recognized the potential of gamified approaches to create safe spaces for emotional expression. The initiative received substantial backing through a $340,000 grant from the New York Life Foundation, demonstrating significant institutional confidence in this innovative approach.
What makes this program particularly noteworthy is its structured implementation:
It runs as a 10-week program
It’s being tested across seven partner organizations nationwide
Each partner site receives $15,000 to support implementation
The program includes continuous consultation and support
As Susana Calley, director of the Blue Ridge Hospice Center for Hope & Healing, described it, the program represents “a powerful convergence of creativity and therapeutic support” for grieving youth.
The Collaboration Between Clinical Expertise and Game Design
At the heart of the “Adventures in Grief” program is a remarkable collaboration between mental health expertise and game design principles. This partnership demonstrates how interdisciplinary approaches can create powerful therapeutic tools.
The program was co-developed by:
Tina Thomas: A social worker from Blue Ridge Hospice bringing clinical grief support expertise
Dr. Elizabeth Kilmer: A training specialist and researcher from Save Point Behavioral Health contributing behavioral health insights
This collaboration ensures the game module balances engaging gameplay with evidence-based therapeutic techniques. The program doesn’t simply adopt gaming elements superficially but integrates them meaningfully into the therapeutic process.
The training component further highlights this clinical-creative fusion:
20 hours of facilitator training provided to grief professionals
Up to 24 grief professionals can be trained at each partner site
How Tabletop Role-Playing Supports Grief Processing
Tabletop role-playing games offer unique therapeutic benefits for grief processing that traditional talk therapy might not provide. These benefits stem from the game’s inherent structure and social dynamics.
Key Therapeutic Elements of Tabletop RPGs for Grief:
Emotional displacement through characters: Players can express difficult feelings through their characters, creating emotional distance that makes processing grief less overwhelming
Metaphorical processing: Game scenarios can mirror grief challenges, allowing participants to work through emotions in a symbolic context
Community building: The collaborative nature of tabletop games fosters connections between bereaved young people who might otherwise feel isolated
Agency and control: In a time when grief can make young people feel powerless, game mechanics provide structured choices and consequences
Narrative meaning-making: Creating and participating in stories helps bereaved individuals construct meaning from their loss experiences
The program specifically aims to “foster emotional healing through creative, low-risk social interactions guided by professional grief counselors.” This approach recognizes that traditional support groups might feel intimidating or unappealing to adolescents and young adults, while a gamified approach leverages familiar formats that reduce stigma and increase engagement.
By embedding therapeutic principles within an engaging game framework, Blue Ridge Hospice has created an environment where grief work happens organically through play, storytelling, and connection—essential elements that align perfectly with effective bereavement support for younger populations.
The Science Behind Gamification in Grief Support
When we lose someone we love, finding ways to process our grief can feel overwhelming. Traditional talk therapy and support groups are valuable, but they don’t work for everyone—especially young people who may struggle to verbalize complex emotions. This is where innovative approaches like Blue Ridge Hospice’s “Adventures in Grief” program come in, using tabletop role-playing games to create new pathways for emotional healing.
Psychological Mechanisms of Therapeutic Gaming
Games offer unique psychological benefits that make them particularly effective for grief processing. Understanding these mechanisms helps explain why tabletop role-playing games like those used in the “Adventures in Grief” program can be so powerful.
Cognitive Load Theory explains one fundamental way games help with grief. Our brains have limited capacity to focus on multiple things at once. During intense grief, intrusive thoughts and overwhelming emotions can dominate our mental landscape. Games demand significant attention and concentration, effectively giving our minds a needed break from grief’s constant presence. This isn’t about avoiding grief, but rather creating space where healing can begin without being overwhelmed.
The psychological benefits of therapeutic gaming include:
Emotional displacement through characters: Players can express difficult feelings through their game characters, creating emotional distance that makes processing grief less overwhelming
Agency and control: Grief often leaves people feeling powerless. Game mechanics provide structured choices and consequences, restoring a sense of control
Metaphorical processing: Game scenarios can mirror grief challenges, allowing participants to work through emotions in a symbolic context
Active engagement: Unlike passive media consumption, games require players to make decisions and take actions, engaging different parts of the brain
Flow state induction: Games can create what psychologists call “flow”—a state of complete immersion that provides relief from emotional distress
Research shows that bereaved players often make meaning of their loss through gaming experiences in two important ways:
By connecting in-game emotions directly with emotions experienced during bereavement
By gaining new perspectives on their loved one’s death by interpreting in-game situations
Creating Safe Emotional Spaces Through Fantasy Contexts
Fantasy settings provide a crucial psychological buffer that makes exploring difficult emotions safer. This is particularly important when working with bereaved young people who may find direct discussions about death overwhelming.
How fantasy contexts create emotional safety:
Symbolic distance: The fantasy world creates separation between the player and painful realities, allowing exploration of feelings without being overwhelmed
Permission to play: Even during grief, which can feel like a time when joy is inappropriate, fantasy games give explicit permission to experience positive emotions
Character as emotional proxy: Players can express feelings through their characters that they might struggle to acknowledge directly
Shared imaginative space: The collaborative nature of tabletop games means no one faces difficult emotions alone—the group navigates challenges together
The “Adventures in Grief” program specifically utilizes these elements by creating a structured 10-week program where professional grief counselors guide participants through game scenarios designed to foster emotional healing. As Susana Calley, director of the Blue Ridge Hospice Center for Hope & Healing, described it, the program represents “a powerful convergence of creativity and therapeutic support.”
Evidence-Based Approaches to Creative Grief Therapy
While gamified approaches to grief support are relatively new, they build upon a solid foundation of evidence-based creative therapies. Research increasingly supports the effectiveness of these approaches, particularly for young people.
Research findings on creative approaches to grief therapy:
Studies show that therapeutic art making serves four purposes that echo established grief processing models: confronting mortality, meaning making, crisis resolution, and authentic emotional expression
Research on bereaved video game players identified seven themes of meaning-making experiences: recalling memories, avoiding engagement with pain, recognizing positive emotions, acknowledging the deceased’s perspective, reviewing the meaning of loss, planning a better future, and fulfilling wishes
Evidence suggests that creative therapies help facilitate “continuing bonds” with the deceased—a healthy way of maintaining connection while moving forward
Established creative therapy approaches that inform gamified grief support:
Addresses trauma before grief processing can occur
Expressive Arts Therapy
Visual art, music, writing, movement
Allows expression of emotions difficult to verbalize
Narrative Therapy
Storytelling, externalization, meaning-making
Helps create coherent narratives about loss
Play Therapy
Symbolic play, emotional expression through toys/games
Particularly effective for children processing loss
The Blue Ridge Hospice program combines these evidence-based elements with the engaging framework of tabletop role-playing games. The program’s implementation across seven partner organizations nationwide—with $15,000 in funding for each site and 20 hours of facilitator training for up to 24 grief professionals—demonstrates a serious commitment to developing evidence for this innovative approach.
Why this matters for different audiences:
For hospice professionals: Gamified approaches offer new ways to engage clients who might not respond to traditional support groups, particularly younger populations
For caregivers: These approaches provide structured activities that can help process your own grief while supporting others
For family members: Understanding these mechanisms can help you support loved ones who might benefit from alternative grief processing methods, especially adolescents and young adults
By grounding innovative approaches in established psychological principles and evidence-based practices, programs like “Adventures in Grief” represent not just creative experimentation, but a thoughtful evolution of bereavement support that meets people where they are and provides new pathways to healing.
Benefits for Bereaved Adolescents and Young Adults
Grief is a deeply personal journey that can feel especially isolating for adolescents and young adults. Traditional bereavement support methods don’t always resonate with younger generations who may struggle to verbalize complex emotions or feel uncomfortable in conventional support group settings. Blue Ridge Hospice’s innovative “Adventures in Grief” program offers a fresh approach by using tabletop role-playing games to create engaging, meaningful spaces for grief work.
Engagement Through Familiar Gaming Frameworks
Many young people already have experience with gaming, making tabletop role-playing games like those used in the “Adventures in Grief” program an approachable entry point to grief support. This familiarity reduces the stigma and resistance that might come with traditional therapy.
Why gaming frameworks work:
They create psychological safety – A psychological theory that explains why people engage deeply with video games during grief is Cognitive Load Theory. Games demand significant attention and concentration, giving the mind a structured break from the constant presence of grief without avoiding it entirely.
They offer appropriate emotional distance – Through characters and fantasy settings, young people can process difficult emotions at arm’s length before internalizing insights.
They provide structure and predictability – Gaming has clear rules and expectations, offering comforting structure during a time when life feels chaotic and unpredictable.
They balance seriousness with play – The “Adventures in Grief” program recognizes that healing doesn’t always need to feel heavy. As Tina Thomas, the Blue Ridge social worker who developed the program, understood, incorporating elements of play can make grief work more accessible.
Young people who might refuse traditional counseling often willingly participate in gaming sessions because they don’t immediately feel like “therapy.” The 10-week structure of the Blue Ridge program provides consistent support while maintaining the engaging qualities that keep participants returning.
Building Peer Connections During Isolation
Grief can be profoundly isolating, especially for young people who may be the only one in their peer group experiencing significant loss. Tabletop role-playing games create natural communities of support.
How gaming builds meaningful connections:
Shared experiences create bonds – Playing together through a 10-week program allows relationships to develop organically among people who truly understand each other’s grief journey.
Collaborative storytelling fosters trust – Working together toward common goals in the game world builds trust that can extend to sharing real-life experiences.
Gaming provides social scripts – For those who find social interaction difficult, especially during grief, games provide helpful structure and roles.
Community extends beyond sessions – The connections formed during game sessions can develop into supportive friendships that continue outside the formal program.
As Dr. Candi Cann, a Baylor University professor who studies grief in digital spaces, explains: “Online spaces are very real spaces. They provide communities of support and a lot that we may not get in our real-life spaces. Some people feel safer and it can supplement our real life now.”
Expressing Difficult Emotions Through Character Play
One of the most powerful aspects of role-playing games is how they allow participants to express and explore emotions through their characters that they might struggle to acknowledge directly.
Benefits of emotional expression through characters:
Emotional displacement – Players can express difficult feelings through their game characters, creating emotional distance that makes processing grief less overwhelming.
Trying different responses – Characters can experiment with various ways of responding to loss and challenge, allowing players to explore coping strategies safely.
Addressing uncomfortable topics – Topics that might feel too painful to discuss directly can be approached through character interactions and game scenarios.
Processing complex emotions – Anger, guilt, regret, and other difficult emotions can be explored through character actions and reactions.
The “Adventures in Grief” program, co-developed by Tina Thomas and Dr. Elizabeth Kilmer, carefully designs game scenarios that mirror grief challenges while maintaining the engaging qualities of gameplay. This balance allows participants to process emotions without feeling overwhelmed or exposed.
Developing Coping Skills Through Narrative Challenges
Stories have always been powerful tools for making meaning of difficult experiences. Tabletop role-playing games create interactive narratives that help participants develop practical coping skills that transfer to real life.
Coping skills developed through narrative play:
Problem-solving under pressure – Game scenarios require creative thinking and adaptation, building resilience that serves well during grief.
Emotional regulation – Managing character responses to in-game challenges helps players practice regulating their own emotional responses.
Meaning-making – Creating and participating in stories helps bereaved individuals construct meaning from their loss experiences.
Future orientation – Game narratives that move forward help participants envision their own path forward after loss.
Research on bereaved video game players has identified seven themes of meaning-making experiences that emerge through gaming:
Meaning-Making Theme
How It Helps
Recalling memories
Games trigger meaningful memories of the deceased
Avoiding overwhelming pain
Provides structured breaks from grief’s intensity
Recognizing positive emotions
Creates safe space to feel joy without guilt
Acknowledging the deceased’s perspective
Helps see loss from different viewpoints
Reviewing the meaning of loss
Facilitates integration of loss into life narrative
Planning a better future
Encourages forward thinking and hope
Fulfilling wishes
Provides ways to honor the deceased
The structured yet creative nature of tabletop role-playing games makes them uniquely suited to developing these coping skills. As Christina Thomas from Blue Ridge Hospice explained, “The creativity and social interactions that take place during our specialized tabletop RPG game will create a fertile ground for healing.”
How Caregivers and Family Members Can Support This Process
If you’re supporting a bereaved young person who might benefit from this approach:
Recognize gaming as legitimate grief work – Rather than seeing gaming as escape or avoidance, understand it can be a meaningful way to process loss.
Consider established programs – Look into programs like Blue Ridge Hospice’s “Adventures in Grief” or similar initiatives at hospice organizations.
Establish healthy boundaries – While gaming can be therapeutic, balance is important. Research suggests moderate gaming (less than one hour daily) is most beneficial for reducing loneliness.
Participate when appropriate – Some young people might welcome your participation in their gaming world as a way to connect and share their experience.
Be patient with the process – Healing through creative engagement takes time and may not look like traditional grief work.
By embracing innovative approaches like tabletop role-playing games for grief support, we open new doors for young people to process loss in ways that feel natural, engaging, and meaningful to them. The success of Blue Ridge Hospice’s program, which received a substantial $340,000 grant from the New York Life Foundation and is being tested across seven partner organizations nationwide, demonstrates the recognized potential of this approach to transform bereavement care for younger generations.
Implementation Across Hospice Organizations
Bringing innovative approaches like Blue Ridge Hospice’s “Adventures in Grief” program to your organization requires careful planning, adequate resources, and proper evaluation methods. This tabletop role-playing game approach to bereavement support has shown promising results for adolescents and young adults, and the multi-site testing model currently underway provides valuable insights for hospice organizations considering similar programs.
The Multi-Site Testing Model: Lessons from Seven Partner Organizations
Blue Ridge Hospice’s innovative approach to bereavement care is being tested across seven partner organizations nationwide, creating a robust framework for understanding how this model works in diverse settings. These partner organizations include:
Avow Hospice (Naples, Florida)
Children’s Bereavement Center Rio Grande Valley (Harlingen, Texas)
Connections Plus (Lexington, VA)
EverHeart Hospice (Greenville, Ohio)
Hospice of the Chesapeake-Chesapeake Life Center (Severna Park, Maryland)
The Elizabeth Hospice (Escondido, California)
The Grief Center of Southwest Colorado (Durango, Colorado)
These organizations were selected through an extensive application process that evaluated several key factors:
Population served
Number of adolescents and young adults served
Ability to participate fully in training
Agreement to start a group
The multi-site testing approach offers several advantages:
Diverse geographic representation ensures the program can be adapted to different regional contexts
Various organizational structures (from dedicated grief centers to full-service hospices) demonstrate implementation flexibility
Different population demographics help identify how the program works across various communities
Shared learning opportunities allow organizations to benefit from each other’s experiences
Each partner site commits to offering at least one 10-week “Adventures in Grief” group in early 2025, with the expectation that they will continue offering the program in some capacity after the initial funding period ends. This sustainability focus ensures long-term impact beyond the initial research phase.
Training Requirements for Grief Professionals
Implementing a therapeutic gaming program requires specialized training that blends clinical grief support expertise with gaming facilitation skills. Blue Ridge Hospice has developed a comprehensive training program for grief professionals at partner sites.
Training structure:
20 hours of facilitator training
Up to 24 grief professionals can be trained at each partner site
Virtual training sessions conducted over 10 weeks
Specific schedule: Thursdays from 2:00 to 4:00 PM ET (11:00 AM to 1:00 PM PT)
The training dates for the current cohort include:
September 12th, 19th, and 26th, 2024
October 10th, 17th, 24th, and 31st, 2024
November 7th, 14th, and 21st, 2024
Training resources provided:
The “Adventures Through Grief” therapeutically-applied role-playing game (TA-RPG) Facilitation Guide
The grief-specific TA-RPG module
A copy of the book “Therapeutically Applied Role-Playing Games” by Elizabeth D. Kilmer, PhD, Adam D. Davis, MAEd, Jared N. Kilmer, PhD, and Adam R. Johns, MA, LMFT
Marketing materials toolkit to promote the “Adventures Through Grief” group
Partner sites must have at least one and up to four grief professionals who can commit to the full training schedule and have the capacity to implement the program. This ensures adequate staffing while maintaining a manageable training cohort size.
Funding and Resource Considerations
Financial and resource planning is crucial for successful implementation of gamified bereavement programs. The Blue Ridge Hospice model provides valuable insights into funding structures and resource needs.
Funding sources and allocation:
The program was financed through a $340,000 grant from the New York Life Foundation
Each partner site receives $15,000 to support program implementation
Funds are disbursed in two payments—one in fall 2024 and one in fall 2025
How implementation funds can be used:
Staffing costs
Program supplies
Food and drinks for participants
Marketing efforts
Additional resources required:
Physical space for in-person meetings
Gaming supplies and materials
Staff time for recruitment and program management
Administrative support for data collection and reporting
Organizations considering this approach should evaluate their current resources and potential funding sources. The New York Life Foundation’s Grief Reach Grant Program has been a significant supporter of innovative bereavement initiatives, but other foundations, community grants, and organizational budgets may also provide funding opportunities.
Sustainability planning: Partner sites must agree to continue offering the program in some capacity after the initial funding period ends. This requires planning for:
Ongoing staffing allocation
Future funding sources
Integration into existing bereavement service offerings
Potential adaptation based on initial outcomes
Measuring Outcomes and Program Effectiveness
Evaluating the effectiveness of bereavement programs is essential but often challenging. The “Adventures in Grief” program incorporates robust evaluation methods to measure outcomes and demonstrate impact.
Evaluation requirements for partner sites:
Must be able to reliably conduct self-report surveys
Must provide Blue Ridge Hospice with required data
Must commit to recruiting a minimum of four teens or young adults as participants
Research leadership: Blue Ridge Hospice has enlisted licensed clinical psychologists Elizabeth Kilmer, PhD, and Jared Kilmer, PhD, to lead research efforts aimed at publishing a comprehensive paper on the efficacy of tabletop role-playing games as grief interventions.
Areas of assessment:
Grief measures
Social isolation
Loneliness
Program engagement and retention
Evaluation approaches in bereavement programs:
Evaluation Type
Description
Benefits
Challenges
Satisfaction surveys
Feedback on program experience
Easy to implement, provides immediate feedback
Doesn’t measure clinical outcomes
Pre/post assessments
Measures change over time using standardized tools
Provides quantifiable outcomes, allows comparison
Requires validated tools, participant compliance
Qualitative feedback
Collects stories and experiences
Captures nuanced impacts, provides rich data
Time-intensive to analyze, subjective
Attendance and engagement
Tracks participation rates
Simple to measure, indicates program appeal
Doesn’t measure quality of experience
Recommended assessment tools:
CORE-10: A 10-question assessment measuring psychological distress
Bereavement-specific measures: Tools specifically designed for grief assessment
Custom program evaluations: Tailored to the specific goals of the program
The research component of the “Adventures in Grief” program addresses a critical gap in existing research by evaluating the applicability and impact of tabletop role-playing games on bereaved adolescents and young adults through standardized assessments.
Getting Started: Next Steps for Your Organization
If your hospice organization is interested in implementing a similar gamified approach to bereavement support, consider these steps:
Assess your current bereavement services and identify gaps in support for adolescents and young adults
Gauge interest and need within your service population
Identify potential staff members who would be interested in training
Explore funding opportunities within your organization and through external grants
Connect with organizations currently implementing these programs for guidance
Develop an evaluation plan to measure outcomes from the beginning
While the current cohort of partner organizations has already been selected, Blue Ridge Hospice’s successful model provides a blueprint that other organizations can adapt. The growing evidence base from this multi-site testing will help inform future implementations and potentially open doors for expanded training opportunities.
By thoughtfully implementing gamified approaches to bereavement support, hospice organizations can reach young people who might otherwise not engage with traditional support services, providing them with creative, engaging pathways to process grief and build resilience.
While Blue Ridge Hospice’s “Adventures in Grief” program demonstrates the powerful potential of tabletop role-playing games for bereavement support, the principles of gamification can be applied more broadly across hospice and palliative care services. The success of this innovative approach invites us to explore how similar game-based interventions might benefit patients and families throughout the entire hospice journey.
Applications in Pediatric Palliative Care
Children facing serious illness have unique needs that game-based approaches can address in particularly effective ways. Games create a bridge between the clinical world and the child’s natural way of processing information and emotions.
Key benefits of gamification in pediatric palliative care:
Reduces anxiety and fear – Virtual reality and immersive games can distract children during medical procedures, creating a more positive experience
Improves treatment compliance – Games like Re-Mission, developed specifically for pediatric cancer patients, have demonstrated significant improvements in medication adherence and self-care behaviors
Creates safe spaces for emotional expression – Fantasy contexts allow children to express difficult feelings about illness that might be too overwhelming to discuss directly
Restores a sense of control – When illness takes away so much agency, games provide structured opportunities for children to make meaningful choices
Practical applications currently being used:
Therapeutic gaming programs like the one at C.S. Mott Children’s Hospital provide bedside gaming experiences to assist in reaching therapeutic goals for hospitalized children
Virtual reality experiences that transport children beyond the hospital environment, reducing feelings of isolation and confinement
iPad programs with specialized apps that combine entertainment with therapeutic goals, helping children understand their conditions and treatments
LEGO robotics programs that teach basic coding while keeping children’s minds engaged during hospital stays
For hospice organizations considering implementing gaming approaches for pediatric patients, start with these practical steps:
Assess what technology and gaming resources you currently have available
Identify staff members who have personal interest or experience with gaming
Consider partnerships with local gaming groups or technology companies
Start small with tablet-based games and expand as resources allow
Document outcomes to build support for program expansion
Supporting Adult Patients Through Game-Based Interventions
While children may seem like the natural audience for games, adults with serious illness can also benefit significantly from game-based interventions. These approaches can address symptom management, emotional processing, and quality of life in ways that complement traditional care.
Benefits for adult patients:
Meaningful distraction – Games provide engaging activities during treatment sessions, hospital stays, or periods of limited mobility
Cognitive stimulation – Mental engagement through games can help maintain cognitive function and provide intellectual stimulation
Social connection – Multiplayer games create opportunities for meaningful interaction even when physical limitations restrict other activities
Symptom management – Some games are specifically designed to help patients manage symptoms like pain, anxiety, or depression
Types of games being used with adult patients:
Game Type
Description
Benefits
Card games
Discussion-based card games about end-of-life topics
Creates non-confrontational environment to discuss important decisions
Role-playing games
Structured narrative games with character development
Allows emotional expression through character play
Digital health games
Apps specifically designed for symptom tracking and management
Improves treatment adherence and patient engagement
Virtual reality
Immersive experiences that transport patients beyond their current environment
Reduces pain perception and anxiety during procedures
Research published in Palliative and Supportive Care identified 53 studies using games in palliative care, with most focusing on role-play (29 studies) and card games (17 studies). These games were primarily aimed at empowering patients and, in some cases, extended to families and caregivers.
Real-world examples:
“Nothing Left Unsaid” is a game designed to spark meaningful conversations during family gatherings or visits to hospice
“Elephant in the Room” helps prepare family members for future decision-making roles through structured conversations
“Now and Then” guides players through past, present, and future decisions to help get affairs in order
Family-Centered Gaming Approaches During Illness
The illness journey affects the entire family system. Game-based approaches can create meaningful connections and support for everyone involved in the care journey.
How family gaming supports the hospice journey:
Creates shared experiences during a challenging time
Normalizes difficult conversations about illness, treatment decisions, and end-of-life planning
Provides respite from the emotional intensity of caregiving
Builds lasting memories that family members will cherish
Reduces isolation for both patients and caregivers
Practical family gaming approaches:
Memory-making activities like creating memory boxes or recording life stories can be structured as collaborative family games
Storytelling games that encourage sharing of family history and important memories
Decision-making games that help families navigate complex healthcare choices together
Legacy projects structured as cooperative games where family members contribute to creating something meaningful together
Implementation strategies for hospice organizations:
Start with familiar formats – Begin with card or board games that families already know, then gradually introduce more specialized therapeutic games
Create lending libraries – Develop a collection of therapeutic games that families can borrow to use at home
Train volunteers – Equip hospice volunteers with skills to facilitate game sessions with families
Document outcomes – Collect stories and feedback about how games have supported families to build evidence for your program
Consider cultural factors – Ensure games are culturally appropriate and accessible for the diverse families you serve
Getting Started with Gamification in Your Organization
If you’re interested in expanding gamification approaches in your hospice organization, consider these steps:
Assess current resources – What technology, games, and interested staff do you already have?
Start small – Begin with one population or service area where games might be particularly beneficial
Build partnerships – Connect with local gaming stores, technology companies, or universities that might support your efforts
Learn from others – Reach out to organizations like Blue Ridge Hospice that are already implementing these approaches
Measure impact – Develop simple ways to track how game-based interventions affect quality of life, symptom management, and family satisfaction
The success of Blue Ridge Hospice’s “Adventures in Grief” program, which received a substantial $340,000 grant from the New York Life Foundation, demonstrates the recognized potential of gamification in hospice care. By thoughtfully expanding these approaches beyond bereavement to the entire hospice journey, organizations can create more engaging, effective support for patients and families during one of life’s most challenging transitions.
Reducing Caregiver Burden Through Gamified Support
Caregiving—whether as a professional or family member—can be profoundly rewarding, but it also comes with significant emotional and physical challenges. The innovative approach of gamification, as demonstrated by Blue Ridge Hospice’s “Adventures in Grief” program, offers promising new ways to support not only those experiencing grief but also the caregivers who support them throughout the hospice journey.
Professional Caregiver Benefits: Preventing Compassion Fatigue
Compassion fatigue is a very real concern for hospice professionals who provide emotional support day after day. The statistics on burnout in healthcare are sobering, with many caregivers experiencing symptoms that affect both their personal wellbeing and their ability to provide quality care.
Warning signs of compassion fatigue include:
Avoiding responsibilities
Withdrawing from colleagues and loved ones
Procrastinating on important tasks
Missing work
Turning to unhealthy coping mechanisms like substance use or overeating
When these symptoms intensify, many hospice professionals lose connection with their initial calling to help others. For organizations, this burnout pattern typically results in lower job satisfaction, increased staff turnover, and a higher risk of errors in service delivery.
How gamification helps prevent compassion fatigue:
Creates psychological distance – Game-based approaches allow professionals to engage with emotional content through a protective framework that reduces direct emotional impact
Provides structured engagement – Rather than facing overwhelming emotional situations without clear boundaries, gamified approaches offer structured ways to process difficult experiences
Offers immediate validation – Gamification provides real-time feedback and recognition, which can boost morale and improve feelings of self-esteem during challenging work
Builds team cohesion – Collaborative gaming experiences strengthen connections between team members, creating stronger support networks
Research shows that staying well and preventing burnout is more effective than addressing it after it develops. Gamified approaches can be integrated into existing self-care practices for hospice professionals:
Traditional Self-Care Practice
Gamified Enhancement
Team debriefing sessions
Structured role-playing scenarios to process difficult cases
Continuing education
Interactive learning modules with achievement tracking
Peer support
Collaborative problem-solving games that build team resilience
Mindfulness practice
Guided meditation apps with progress tracking
As one home care software provider noted, “Agencies can also use gamification to alter unwanted behaviors and inspire caregivers and staff to be at their best at work – simultaneously reducing work-related stress. Think ‘more carrot, less stick’!”
Family Caregiver Applications: Building Resilience During Caregiving
Family caregivers face unique challenges as they navigate both the practical demands of caregiving and the emotional journey of anticipatory grief. Gamification principles can be adapted to support family caregivers in building resilience throughout the hospice journey.
The five domains of caregiver resilience that gamification can support:
Roles – Gamified approaches can help family members understand and adapt to their caregiving roles through structured learning and practice
Relationships – Interactive activities can strengthen connections between the caregiver and their loved one, even as relationships change
Realities – Game-based scenarios can help caregivers develop problem-solving skills for real-world challenges
Rewards – Recognition systems can highlight the meaningful aspects of caregiving that might otherwise be overlooked
Readiness – Skill-building games can increase caregiver confidence in providing care
Family caregivers can benefit from gamified approaches in several practical ways:
Skill development through interactive tutorials rather than overwhelming printed materials
Stress reduction through brief, engaging activities that provide meaningful breaks
Community building through shared virtual experiences with other caregivers
Recognition systems that acknowledge the important work they’re doing day after day
Research on gamified family leisure during challenging times has shown promising results. One study found that families who participated in gamified leisure activities during COVID-19 lockdowns experienced reduced negative emotional states. Participants reported that these activities helped them “enjoy family time” (87.5%) and created a sense of “disconnection from reality” (40.6%) that provided relief from stress.
Post-Loss Support Through Continued Engagement
The period after a loved one’s death can be particularly isolating for both family caregivers and the professionals who cared for the patient. Gamified bereavement support, like Blue Ridge Hospice’s “Adventures in Grief” program, offers continued engagement that addresses this isolation while providing structured ways to process grief.
Benefits of continued engagement through gamification:
Maintains connection to support systems when traditional support groups might feel overwhelming
Provides a gradual transition from the intensive caregiving period to life after loss
Creates safe spaces for emotional expression through character play and symbolic activities
Builds new coping skills that transfer to real-life challenges
Blue Ridge Hospice’s 10-week “Adventures in Grief” program demonstrates how structured, gamified support can be particularly effective for bereaved individuals. The program uses a Dungeons and Dragons-style tabletop role-playing game to foster “emotional healing through creative, low-risk social interactions guided by professional grief counselors.”
For family caregivers who have lost a loved one, continued engagement through gamified approaches can help address several common challenges:
Loss of purpose after the caregiving role ends
Processing complex emotions like relief, guilt, and profound grief
Rebuilding identity beyond the caregiver role
Creating new routines and social connections
For professional caregivers, participating in or facilitating gamified bereavement support can provide closure and meaning after a patient’s death, helping to prevent compassion fatigue from accumulating over time.
Implementing Gamified Support in Your Organization or Home
Whether you’re a hospice professional looking to implement gamified approaches in your organization or a family caregiver interested in these techniques, here are some practical steps to get started:
Start small with simple gamified elements that don’t require extensive resources
Focus on specific challenges that would benefit most from a gamified approach
Involve potential participants in designing the approach to ensure it meets their needs
Measure impact through both formal assessments and informal feedback
Be willing to adapt based on what works and what doesn’t
Blue Ridge Hospice’s partnership with seven organizations nationwide demonstrates the growing recognition of gamification’s potential in hospice care. As Susana Calley, director of the Blue Ridge Hospice Center for Hope & Healing, described it, these programs represent “a powerful convergence of creativity and therapeutic support” that can benefit everyone involved in the hospice journey.
By embracing innovative approaches like gamification, we can create more engaging, effective support systems that reduce burden and build resilience for both professional and family caregivers throughout the hospice journey and beyond.
Adapting Role-Playing Games for Different Populations
Blue Ridge Hospice’s “Adventures in Grief” program demonstrates the powerful potential of tabletop role-playing games (TTRPGs) for bereavement support. However, to be truly effective, these therapeutic approaches must be thoughtfully adapted to meet the unique needs of diverse populations. Let’s explore how to customize these innovative tools for different ages, cultures, and abilities.
Age-Specific Considerations and Modifications
The effectiveness of therapeutic role-playing games depends significantly on tailoring the experience to match the developmental stage and interests of participants. Blue Ridge Hospice’s program specifically targets adolescents and young adults, but the principles can be adapted across the lifespan.
For Children (Ages 6-12):
Children in this age range process grief differently than adults or even teenagers. They may express grief through play rather than words and often engage in repetitive questioning about death.
Simplify game mechanics – Reduce complex rules and calculations that might frustrate younger players
Incorporate concrete representations – Use physical objects, drawings, or visual aids to represent abstract concepts
Shorten session duration – Limit sessions to 30-45 minutes to match shorter attention spans
Include physical movement – Incorporate opportunities to stand, move, or act out scenarios
Use familiar themes – Draw from stories, characters, or settings children already know and enjoy
Children in this age group might play-act through games as a way of processing grief when verbal expression is difficult. They may also use play to fantasize about how they could have prevented the death as a way of gaining control over the situation.
For Adolescents (Ages 13-17):
Blue Ridge Hospice’s “Adventures in Grief” program is specifically designed for this age group, recognizing their unique developmental needs.
Incorporate identity exploration – Create character development opportunities that allow teens to explore different aspects of themselves
Address social concerns – Include scenarios that acknowledge peer relationships and social identity
Balance structure with autonomy – Provide clear frameworks while allowing for independent decision-making
Use relevant cultural references – Incorporate elements from current teen culture to increase engagement
Create space for both verbal and non-verbal expression – Some teens may prefer to express emotions through their character rather than direct conversation
For Young Adults (Ages 18-26):
This is the second target group for Blue Ridge Hospice’s program, recognizing that young adults often fall through the cracks of bereavement support.
Address life transition themes – Incorporate scenarios related to career, relationships, and identity formation
Acknowledge complex grief responses – Create space for exploring complicated emotions like guilt, regret, or relief
Balance playfulness with depth – Maintain engaging gameplay while allowing for meaningful emotional exploration
Provide flexibility in scheduling – Accommodate work and education commitments
Create opportunities for leadership – Allow participants to take on increasing responsibility in the game world
For Older Adults:
While not the primary target of Blue Ridge Hospice’s current program, older adults can also benefit from therapeutic gaming approaches.
Focus on life review and meaning-making – Create scenarios that encourage reflection on life experiences and values
Incorporate familiar cultural references – Draw from historical events and cultural touchpoints relevant to their generation
Simplify without infantilizing – Adapt rules for accessibility without making them feel childish
Address physical comfort needs – Ensure comfortable seating, good lighting, and appropriate session length
Consider sensory changes – Use larger text, high-contrast materials, and clear audio
Cultural Sensitivity in Game Design
Effective therapeutic gaming must respect and incorporate cultural differences in how grief is expressed and processed. The Blue Ridge Hospice program is being tested across seven partner organizations nationwide, allowing for adaptation to different regional contexts.
Key principles for cultural sensitivity:
Recognize diverse grief expressions – Different cultures have varying norms around expressing grief publicly versus privately
Respect spiritual and religious frameworks – Incorporate or acknowledge diverse beliefs about death, afterlife, and mourning practices
Consider family structures – Adapt scenarios to reflect different family configurations and roles
Be mindful of language and metaphors – Choose words and imagery that resonate across cultural backgrounds
Involve community representatives – Consult with cultural leaders when adapting programs for specific communities
Practical approaches to cultural adaptation:
Flexible character creation – Allow participants to create characters that reflect their cultural background and values
Diverse scenario options – Offer multiple ways to approach challenges that honor different cultural problem-solving approaches
Adaptable ritual elements – Include opportunities to incorporate culturally-specific rituals or remembrances
Multilingual resources – Provide materials in multiple languages when serving diverse communities
Cultural humility training – Ensure facilitators receive training in cultural sensitivity and humility
Accessibility for Various Cognitive and Physical Abilities
Therapeutic role-playing games should be accessible to individuals with diverse cognitive and physical abilities. The inherent flexibility of tabletop role-playing games makes them particularly adaptable.
For individuals with cognitive differences:
Modular complexity – Design games with adjustable levels of complexity that can be tailored to participants’ cognitive abilities
Visual supports – Incorporate visual schedules, character cards, and other aids to support understanding
Memory aids – Provide reference sheets, recaps, and other tools to support memory
Flexible pacing – Allow for varying processing speeds and attention spans
For individuals with physical disabilities:
Alternative dice methods – Offer digital dice rollers, oversized dice, or dice towers for those with dexterity challenges
Accessible materials – Use large print, high contrast, and tactile elements
Flexible seating arrangements – Ensure space accommodates mobility devices and allows for position changes
Multiple participation modes – Allow for verbal, written, or assisted communication based on individual needs
Sensory considerations – Be mindful of lighting, sound levels, and other environmental factors
Creating inclusive gaming environments:
Consideration
Adaptation Strategies
Benefits
Visual impairments
Audio descriptions, tactile game pieces, digital character sheets with screen reader compatibility
Ensures full participation regardless of visual ability
Hearing impairments
Visual cues, written instructions, clear sightlines for lip reading
Supports engagement for those with hearing differences
Attention differences
Shorter segments, movement breaks, fidget tools
Helps maintain focus and engagement
Processing speed variations
Advance materials, extra time for decisions, “pause” options
Allows everyone to participate meaningfully
Mobility differences
Accessible venues, adjustable table heights, remote participation options
Ensures physical comfort and equal access
Implementation Strategies for Diverse Populations
When implementing therapeutic role-playing games across diverse populations, consider these practical approaches:
Start with assessment – Understand the specific needs, interests, and abilities of your participant group
Involve participants in adaptation – Ask for input on what would make the game more accessible and engaging
Train facilitators thoroughly – Ensure game masters have skills in both therapeutic techniques and adaptive gaming
Start simple and build – Begin with basic elements and add complexity as participants become comfortable
Gather ongoing feedback – Regularly check in about what’s working and what needs adjustment
Blue Ridge Hospice’s approach of providing 20 hours of facilitator training for up to 24 grief professionals at each partner site demonstrates their commitment to thorough preparation. This training ensures facilitators can effectively adapt the program to meet the needs of their specific communities.
By thoughtfully adapting therapeutic role-playing games to different populations, hospice organizations can extend the benefits of this innovative approach to bereavement support across diverse communities, ages, and abilities. The flexibility and creativity inherent in tabletop role-playing games make them particularly well-suited for customization, allowing for truly person-centered grief support.
Technology Integration Possibilities
As Blue Ridge Hospice’s “Adventures in Grief” program demonstrates the power of tabletop role-playing games for bereavement support, we can explore how technology might enhance and extend these therapeutic approaches. The digital landscape offers exciting possibilities to reach more grieving individuals and provide flexible support options that complement in-person experiences.
Digital Adaptations of Tabletop Concepts
The tabletop role-playing game format used in Blue Ridge Hospice’s program can be adapted to digital platforms while preserving the therapeutic benefits of collaborative storytelling and character development.
Benefits of digital adaptations:
Increased accessibility – Digital platforms remove geographic barriers, allowing participation regardless of location
Flexible scheduling – Asynchronous elements let participants engage when emotionally ready rather than at fixed times
Enhanced visual elements – Digital platforms can incorporate multimedia elements that might enhance the therapeutic experience
Reduced social anxiety – Some participants may feel more comfortable expressing emotions through digital interfaces initially
Digital adaptation options:
Virtual tabletop platforms like Roll20, Foundry VTT, or D&D Beyond provide structured environments for remote role-playing with built-in tools for character sheets, dice rolling, and map visualization
Collaborative storytelling apps such as Storium allow for asynchronous role-playing where participants can take their time crafting responses
Text-based role-playing forums provide spaces for written character development and narrative exploration that can be particularly helpful for those who process emotions through writing
Video game adaptations that incorporate therapeutic elements while providing engaging gameplay
The Handley Library branch has already partnered with Blue Ridge Hospice to offer their “Adventures Through Grief” program, demonstrating how community partnerships can expand access to these innovative approaches. As one participant noted, the program allows them to “tap into your creativity, build interpersonal skills, and learn to train your dragons as their Grief Counselors and Music Therapists take on the role of Game Master.”
Virtual and Hybrid Support Group Models
The COVID-19 pandemic accelerated the adoption of virtual support groups, revealing both their limitations and unique benefits. Hospice organizations are now exploring hybrid models that combine the best of both in-person and virtual approaches.
Current virtual support group offerings:
Many hospice organizations have already embraced virtual support options:
Hospice & Community Care offers a virtual Caregiver Support Group on the third Thursday of each month from 6:30 to 8:00 p.m.
Riverside Hospice provides a virtual support group every Friday at 1:30 p.m.
VITAS Healthcare offers several specialized virtual groups, including ones for LGBTQ+ individuals, Spanish speakers, and men experiencing grief
Hybrid model possibilities:
Blended programs that alternate between in-person and virtual sessions
Concurrent participation options where some group members attend in person while others join remotely
Supplemental digital resources that extend the impact of in-person sessions
Technology lending programs for those without access to devices or internet
As Hospice & Community Care notes in their virtual support group information: “Talk to your hospice social worker about borrowing an iPad if you do not have a computer or other internet-enabled device. If you are unsure how to access the internet, ask one of your hospice team members for assistance.”
Considerations for virtual and hybrid models:
Aspect
In-Person Benefits
Virtual Benefits
Hybrid Approach
Connection
Deeper nonverbal communication
Accessibility for those with mobility issues
Flexible participation options
Engagement
Immersive experience
Participation from comfortable environment
Combination of synchronous and asynchronous elements
Resources
Tangible materials and activities
Digital resources easily shared
Multi-format resources that work in both settings
Facilitation
Easier to manage group dynamics
Broader geographic reach
Trained facilitators comfortable in both environments
Mobile Applications for Continued Support
Mobile applications offer powerful tools for extending bereavement support beyond scheduled sessions, providing resources and connection points during difficult moments.
Current bereavement app landscape:
Several hospice organizations are already utilizing mobile applications to enhance bereavement services:
After Cloud recently launched in the United States and other countries, allowing users to “capture moments in any form” with end-of-life and palliative care specifically in mind
nanaBEREAVEMENT offers personalized text messages to support families during the bereavement process, costing providers only half the price of traditional methods while saving time through automation
Empathy helps families with practical tasks after losing someone, from planning a funeral to claiming benefits to dealing with an estate
Grief-specific apps for individuals:
My Grief Angels creates a global community for mutual support, featuring grief chat and meetup features
Headspace offers meditations specifically designed for coping with grief
Lilies provides tools for processing grief through various features
Potential applications for role-playing game integration:
Character creation and development apps that allow participants to work on their characters between sessions
Journaling tools that prompt reflection on game experiences and their connection to grief
Mindfulness applications with grief-specific content that complements the therapeutic gaming approach
Community platforms that maintain connections between group members outside of formal sessions
As noted by one digital health provider, “In today’s digital age, 33% of Americans prefer texting compared to all other methods of communication.” Mobile applications connect with families “where they spend their time—on their phones—by sending personalized, compassionate messages via text.”
Implementation Considerations
For hospice organizations considering technology integration with therapeutic gaming approaches, consider these practical steps:
Assess your population’s technology access and comfort levels
Start with simple technology integrations before attempting more complex digital adaptations
Provide clear instructions and support for those less comfortable with technology
Maintain the therapeutic focus rather than letting technology become the center of attention
Gather feedback regularly about the technology experience
Blue Ridge Hospice’s innovative approach to bereavement care through tabletop role-playing games provides a strong foundation that can be enhanced through thoughtful technology integration. By combining the power of creative, collaborative storytelling with the accessibility and flexibility of digital tools, hospice organizations can reach more grieving individuals and provide support that meets them where they are—both emotionally and physically.
As we continue to explore these possibilities, it’s important to remember that technology should serve as a tool to enhance human connection rather than replace it. The most effective approaches will likely combine traditional therapeutic wisdom with innovative digital possibilities, creating flexible, accessible pathways to healing for all who are grieving.
Ethical Considerations in Gamified Grief Support
When introducing innovative approaches like Blue Ridge Hospice’s “Adventures in Grief” program, we must carefully consider the ethical dimensions of using games in bereavement support. While tabletop role-playing games offer powerful therapeutic benefits, they also require thoughtful implementation to ensure they support rather than hinder the grief journey.
Maintaining Therapeutic Boundaries Within Play
The unique nature of tabletop role-playing games creates both opportunities and challenges for maintaining appropriate therapeutic boundaries. Unlike traditional therapy, where roles and expectations are clearly defined, gaming environments can blur these lines in ways that require special attention.
Why boundaries matter in therapeutic gaming:
Protection from emotional harm – Clear boundaries prevent participants from becoming overwhelmed by grief emotions that emerge during play
Role clarity – Participants need to understand when the facilitator is acting as a game master versus a clinical professional
Emotional safety – Boundaries create a container that allows for emotional exploration without fear of judgment or overexposure
The overlap between virtual and real-world norms creates unique ethical challenges in gamified approaches. As research on ethical gamification notes, what’s acceptable in a game world (like deception or manipulation) may not be appropriate in therapeutic contexts. This tension requires careful navigation by facilitators.
Practical boundary-setting strategies:
Clear session structure – Begin and end each session with explicit transitions between game play and therapeutic processing
Consent processes – Establish ongoing consent practices where participants can easily indicate when they need to step back
Character separation – Help participants distinguish between in-game character emotions and their personal feelings
Physical space considerations – Create distinct areas for game play versus emotional processing when possible
Blue Ridge Hospice’s comprehensive 20-hour training program for facilitators likely addresses these boundary considerations, preparing grief professionals to navigate the complex interplay between gaming and therapy.
Balancing Fun Elements With Serious Emotional Work
One of the most delicate ethical considerations in gamified grief support is finding the appropriate balance between engaging gameplay and meaningful emotional processing. There can be discomfort around introducing playful elements into grief work, yet research shows that this balance, when struck appropriately, can be powerfully therapeutic.
The ethical tension:
Some may question whether it’s appropriate to make grief work “fun” or “entertaining.” However, research on therapeutic gaming suggests that engagement through enjoyable activities actually enhances intrinsic motivation for behavioral change and emotional processing.
Sustainable participation – Engaging formats increase the likelihood of completing the full therapeutic program
Normalized emotional expression – Playful contexts can make it safer to express difficult feelings
Cognitive respite – Brief periods of enjoyment provide necessary breaks from grief’s intensity
Signs of appropriate balance versus ethical concerns:
Balanced Approach
Ethical Concern
Fun elements serve therapeutic goals
Entertainment becomes primary focus
Emotional processing is integrated
Emotional avoidance through gameplay
Facilitator guides toward growth
Facilitator prioritizes game progression
Participants feel emotionally safe
Participants feel emotionally manipulated
Clear therapeutic framework
Unclear purpose or therapeutic intent
Research on video games and grief processing found that moderate gaming (less than one hour daily) was most beneficial for reducing loneliness, suggesting that balance is key to therapeutic benefit. The structured 10-week format of Blue Ridge Hospice’s program likely helps maintain this balance by providing a clear therapeutic framework.
Ensuring Appropriate Clinical Oversight
For gamified bereavement support to be ethically sound, it must include appropriate clinical oversight throughout development, implementation, and evaluation. Blue Ridge Hospice’s program demonstrates strong clinical foundations through its development and implementation structure.
Elements of appropriate clinical oversight:
Clinical expertise in program development – Blue Ridge social worker Tina Thomas developed the game module in partnership with Dr. Elizabeth Kilmer, a training specialist and researcher from Save Point Behavioral Health
Qualified facilitators – The program provides 20 hours of facilitator training for grief professionals, ensuring clinical competence
Ongoing supervision and consultation – Partner sites receive continuous consultation throughout implementation
Outcome measurement – The program includes research led by licensed clinical psychologists to evaluate efficacy
Ethical risks of inadequate oversight:
Potential harm to vulnerable participants – Without clinical expertise, emotional triggers might not be properly managed
Misrepresentation of therapeutic benefit – Claims about effectiveness should be supported by appropriate evidence
Missed opportunities for intervention – Trained clinicians can identify when participants need additional support
The $340,000 grant from the New York Life Foundation supporting Blue Ridge Hospice’s program enables proper investment in clinical oversight, including the training of up to 24 grief professionals at each partner site. This level of investment in clinical expertise demonstrates a commitment to ethical implementation.
Additional Ethical Considerations for Different Populations
When implementing gamified grief support, ethical considerations may vary based on the specific population being served. While Blue Ridge Hospice’s program focuses on adolescents and young adults, different ethical considerations might apply to other groups.
For children:
Ensure developmentally appropriate content and mechanics
Consider parental/guardian involvement and consent
Be especially attentive to signs of distress or confusion
For older adults:
Address potential stigma around gaming
Ensure physical and cognitive accessibility
Consider cultural attitudes toward grief expression
For culturally diverse populations:
Respect cultural norms around death, grief, and play
Avoid cultural appropriation in game scenarios
Consider language barriers and translation needs
Implementing Ethical Gamified Support in Your Organization
If you’re considering implementing gamified bereavement support in your hospice organization, here are key ethical steps to consider:
Develop clear ethical guidelines specific to your program
Establish robust informed consent processes for participants
Create protocols for addressing emotional distress during sessions
Ensure facilitators receive specialized training in both grief support and gaming facilitation
Implement regular ethical review of program content and practices
Collect feedback from participants about their experience
By thoughtfully addressing these ethical considerations, hospice organizations can harness the therapeutic potential of gamified approaches while maintaining the highest standards of care for bereaved individuals. Blue Ridge Hospice’s careful implementation, with its emphasis on professional training, continuous consultation, and research evaluation, provides a model for ethical practice in this innovative field.
Future Directions for Research and Practice
As Blue Ridge Hospice’s “Adventures in Grief” program demonstrates the promising potential of tabletop role-playing games for bereavement support, we stand at the beginning of an exciting new frontier in grief care. This innovative approach opens numerous possibilities for research and practice development that could transform how we support those experiencing loss.
Expanding the Evidence Base for Gamified Interventions
The $340,000 grant from the New York Life Foundation supporting Blue Ridge Hospice’s multi-site testing model represents a significant investment in building evidence for gamified bereavement interventions. As this program is implemented across seven partner organizations nationwide, it creates a valuable opportunity to gather data on effectiveness across diverse populations and settings.
Current research gaps that need addressing:
Long-term impact studies – Most current research on gamified interventions focuses on immediate outcomes rather than sustained healing
Comparative effectiveness research – Studies comparing gamified approaches to traditional bereavement support methods are needed to understand when and for whom these approaches work best
Mechanism identification – Research that identifies precisely how and why gaming elements support grief processing
Recent research on video games and grief processing has already identified seven themes of meaning-making experiences that emerge through gaming:
Meaning-Making Theme
Description
Research Implications
Recalling memories
Games trigger meaningful memories of the deceased
How specific game elements can be designed to facilitate healthy reminiscence
Avoiding overwhelming pain
Provides structured breaks from grief’s intensity
Optimal balance between engagement and emotional processing
Recognizing positive emotions
Creates safe space to feel joy without guilt
How positive emotions during play might transfer to daily life
Acknowledging the deceased’s perspective
Helps see loss from different viewpoints
Role of perspective-taking in grief resolution
Reviewing the meaning of loss
Facilitates integration of loss into life narrative
How narrative elements in games support meaning-making
Planning a better future
Encourages forward thinking and hope
Transfer of in-game future orientation to real-life planning
Fulfilling wishes
Provides ways to honor the deceased
How symbolic completion of unfinished business affects grief
This emerging research provides a foundation, but more rigorous studies are needed. The collaboration between Blue Ridge Hospice and licensed clinical psychologists Elizabeth Kilmer and Jared Kilmer to publish comprehensive research on tabletop role-playing games as grief interventions represents an important step forward.
Developing Specialized Modules for Different Loss Types
While Blue Ridge Hospice’s current program focuses on adolescents and young adults experiencing any type of loss, future development could include specialized modules tailored to specific loss experiences.
Potential specialized modules could address:
Loss of a parent – Game scenarios that specifically address the unique challenges of parental loss
Loss of a sibling – Modules focusing on the often-overlooked grief of brothers and sisters
Loss through suicide – Carefully designed scenarios that address the complex emotions surrounding suicide loss
Pregnancy and infant loss – Specialized approaches for this particularly difficult type of grief
Ambiguous loss – Modules for situations where there isn’t a clear death (e.g., missing persons, dementia)
Research indicates that different types of loss can trigger distinct grief responses. For example, studies show that bereaved video game players who lost a relative more recently (within 2 years) experienced stronger emotional reactions to game content than those whose loss occurred longer ago. This suggests that specialized modules might need to consider not only the relationship to the deceased but also the recency of the loss.
Development considerations for specialized modules:
Collaborative design teams including both clinical experts in specific loss types and game design professionals
Pilot testing with specific populations to ensure appropriateness and effectiveness
Flexibility to adapt to individual needs within the specialized framework
Cultural sensitivity in addressing how different communities experience specific types of loss
Organizations like the Center for Prolonged Grief at Columbia University are already developing specialized approaches for complicated grief, which could inform the development of specialized gaming modules for those experiencing prolonged grief disorder.
Training the Next Generation of Grief Support Professionals
As gamified approaches to grief support gain traction, comprehensive training programs will be essential to ensure these innovative tools are used effectively and ethically.
Key components of future training programs:
Interdisciplinary education combining therapeutic principles with game facilitation skills
Ethical guidelines specific to the use of games in bereavement support
Practical experience through supervised facilitation opportunities
Ongoing professional development as the field evolves
Blue Ridge Hospice’s current training model—providing 20 hours of facilitator training for up to 24 grief professionals at each partner site—offers a starting point for more comprehensive training programs in the future.
Training program development considerations:
Academic partnerships with universities and professional training organizations like the American Academy of Grief Counseling or the Center for Loss & Life Transition
Certification pathways specifically for gamified grief support facilitation
Integration into existing grief education programs for hospice workers, counselors, and other professionals
Accessibility considerations to ensure diverse professionals can access training
Several organizations are already developing comprehensive grief education programs that could incorporate gamified approaches:
The Dougy Center offers training on their model for counselors and helping professionals working with children, teens, and families who are grieving
The Center for Prolonged Grief at Columbia University provides training in evidence-based assessment and treatment of prolonged grief
Good Grief offers an “Understanding Grief and Loss” training program that educates professionals on key issues surrounding loss, grief, childhood bereavement, and resilience
As one training participant noted about a grief workshop: “I felt very welcomed and encouraged to participate, ask questions, and actively learn. I came back to school today and one of the first students to come to my office is one of the students in my grief group.”
Bridging Current Innovation with Future Possibilities
Blue Ridge Hospice’s “Adventures in Grief” program represents an important bridge between traditional bereavement support and innovative approaches that engage younger generations. By thoughtfully expanding research, developing specialized modules, and training skilled facilitators, the field of grief support can continue to evolve to meet the diverse needs of those experiencing loss.
For hospice professionals, caregivers, and family members interested in these emerging approaches, staying informed about research developments and training opportunities will be key to accessing these innovative tools as they become more widely available. The seven partner organizations currently implementing Blue Ridge Hospice’s program—from Avow Hospice in Florida to The Grief Center of Southwest Colorado—will likely become valuable resources for others interested in similar approaches.
By embracing innovation while maintaining a strong foundation in compassionate care, the field of bereavement support can continue to develop more effective, engaging ways to support people through one of life’s most challenging experiences.
Practical Implementation Guide
Implementing a gamified bereavement program like Blue Ridge Hospice’s “Adventures in Grief” requires careful planning, adequate resources, and a thoughtful approach to overcoming potential resistance. This guide provides practical steps for hospice organizations, caregivers, and family members interested in exploring this innovative approach to grief support.
Starting a Gamified Bereavement Program: Essential Steps
Beginning a therapeutic gaming program for bereavement support involves several key steps to ensure both clinical effectiveness and participant engagement.
1. Assess your organization’s readiness and needs
Evaluate your current bereavement services and identify gaps, particularly for adolescents and young adults
Consider your staff’s interest and capacity to learn new approaches
Determine if your community would benefit from alternative bereavement support options
2. Build your implementation team
Identify staff members with both clinical expertise and interest in gaming
Consider including at least one person with personal experience in tabletop role-playing games
Involve bereavement specialists who understand grief processes
3. Develop your program structure
Blue Ridge Hospice’s model uses a 10-week program format
Determine session frequency, duration, and group size
Create clear participant eligibility criteria and referral processes
4. Secure appropriate training
Blue Ridge Hospice provides 20 hours of facilitator training for partner sites
Training should cover both therapeutic principles and game facilitation
Consider resources like “Therapeutically Applied Role-Playing Games” by Elizabeth D. Kilmer, PhD, and colleagues
5. Prepare necessary materials and space
Acquire appropriate gaming supplies
Ensure your physical space supports both gaming and therapeutic processing
Develop marketing materials to promote the program
6. Establish evaluation methods
Create pre/post assessments to measure program impact
Develop feedback mechanisms for participants
Plan for ongoing program refinement based on outcomes
7. Launch with a pilot group
Start small with a single group to refine your approach
Consider beginning with staff or volunteers to test the format
Gather detailed feedback to improve future iterations
Blue Ridge Hospice’s partnership with the Handley Library branch demonstrates how community collaborations can support implementation. As noted on the library’s website, the program allows participants to “tap into your creativity, build interpersonal skills, and learn to train your dragons as their Grief Counselors and Music Therapists take on the role of Game Master.”
Overcoming Common Challenges and Resistance
Introducing innovative approaches like gamified bereavement support often faces resistance from various stakeholders. Understanding and addressing these concerns proactively is essential for successful implementation.
Common sources of resistance include:
Perceived lack of relevance: Some may question how games relate to serious grief work
Fear of change: Staff may be comfortable with traditional approaches and resistant to new methods
Concerns about fairness and equity: Questions about who benefits and who might be excluded
Lack of understanding: Misconceptions about what therapeutic gaming actually involves
Organizational culture: Traditional hospice cultures may be skeptical of playful approaches to grief
Strategies for overcoming resistance:
Education and communication: Provide clear information about the therapeutic foundations of gamified approaches
Start with clear goals: As noted in research on gamification in education, “One of the biggest mistakes people make when gamifying learning is simply adding game elements. But what we really want to do is start with the end in mind.”
Address concerns about trivialization: Explain how structured play creates psychological safety for exploring difficult emotions
Demonstrate evidence: Share research and outcomes from programs like Blue Ridge Hospice’s initiative
Involve skeptics in planning: Include those with concerns in program development to address their specific issues
Pilot with willing participants: Begin with staff and families who are enthusiastic about the approach
Research on resistance to gamification in workplace settings suggests that transparency and clear communication are crucial: “Providing visibility into the gamification process and ensuring that performance metrics are objective and unbiased, organizations can build trust and confidence in the system, mitigating resistance and fostering acceptance.”
Addressing specific concerns:
Concern
Response Strategy
Key Message
“Games trivialize grief”
Explain psychological safety of symbolic processing
Games create distance that makes emotional processing more accessible
“Traditional methods work fine”
Position as complementary, not replacement
This reaches people who might not engage with traditional support
“We don’t have gaming expertise”
Highlight available training and resources
Blue Ridge Hospice provides comprehensive training for facilitators
“It’s too expensive”
Outline potential funding sources and partnerships
Grants like the New York Life Foundation support innovative approaches
“It only works for young people”
Discuss adaptability for different populations
Core principles can be modified for various age groups
Resources and Support Networks for Implementation
Implementing a gamified bereavement program doesn’t mean starting from scratch. Various resources and support networks can help organizations develop effective programs.
Training and educational resources:
Blue Ridge Hospice’s training program for partner sites
“Therapeutically Applied Role-Playing Games” book by Elizabeth D. Kilmer, PhD, and colleagues
Game to Grow, a nonprofit organization dedicated to using games to improve lives
Hospice Foundation of America’s program “Using Games to Encourage Difficult Conversations”
Funding opportunities:
New York Life Foundation’s Grief Reach Grant Program (funded Blue Ridge Hospice’s program with $340,000)
Local community foundations interested in innovative healthcare approaches
Partnerships with gaming companies or technology firms for in-kind support
Community partnerships to explore:
Public libraries (like Blue Ridge Hospice’s partnership with Handley Library)
Local gaming stores or groups
Schools and universities with game design or mental health programs
Other hospice organizations implementing similar approaches
Digital resources and platforms:
Virtual tabletop platforms for remote implementation
Apps like “Apart of Me” that already use gamification for grief support
HealGrief’s AMF App which offers communities for grieving individuals to connect
Professional networks:
The seven partner organizations working with Blue Ridge Hospice:
Avow Hospice (Naples, Florida)
Children’s Bereavement Center Rio Grande Valley (Harlingen, Texas)
Connections Plus (Lexington, VA)
EverHeart Hospice (Greenville, Ohio)
Hospice of the Chesapeake-Chesapeake Life Center (Severna Park, Maryland)
The Elizabeth Hospice (Escondido, California)
The Grief Center of Southwest Colorado (Durango, Colorado)
Implementation support checklist:
Identify local gaming groups or stores that might provide expertise or volunteers
Connect with other hospice organizations implementing similar programs
Research grant opportunities specifically for innovative bereavement approaches
Develop relationships with mental health professionals experienced in creative therapies
Create a resource library of books, articles, and research on therapeutic gaming
By thoughtfully addressing implementation challenges and leveraging available resources, hospice organizations can successfully introduce gamified bereavement support programs that reach individuals who might not engage with traditional approaches. As Christina Thomas, LCSW, Grief Support Counselor at Blue Ridge Hospice, noted: “We want to innovatively serve young adults who feel socially isolated and want to process their grief but wouldn’t traditionally seek counseling. The creativity and social interactions that take place during our specialized tabletop RPG game will create a fertile ground for healing.”
Conclusion: Transforming Bereavement Support Through Creative Innovation
Blue Ridge Hospice’s groundbreaking “Adventures in Grief” program represents a significant evolution in how we approach bereavement support. By harnessing the power of tabletop role-playing games, this innovative initiative offers new pathways for emotional healing that complement traditional approaches while reaching individuals who might otherwise not engage with bereavement services.
The Evolving Landscape of Grief Support
The field of grief support is undergoing remarkable transformation, moving beyond conventional counseling sessions to embrace more creative and engaging approaches. This evolution reflects our growing understanding of grief’s complexity and the diverse needs of those experiencing loss.
Key trends reshaping bereavement care include:
Personalized approaches that recognize the uniqueness of each grief journey, with hospice bereavement care increasingly tailored to meet individual needs through various options including grief counseling, support groups, and now, gamified experiences
Technology integration that expands access to support through virtual counseling, mobile applications, and digital resources that provide connection and guidance when in-person services aren’t available
Creative therapeutic modalities like Blue Ridge Hospice’s tabletop role-playing program, which joins other innovative approaches such as nature-informed therapy, arts-based interventions, and music therapy
Community-based models that extend support beyond traditional clinical settings into schools, libraries, and other community spaces, as exemplified by Blue Ridge Hospice’s partnership with Handley Library branch
The hospice field is increasingly recognizing that bereavement support must evolve to meet changing family dynamics and needs. As Hospice of the Chesapeake demonstrates through their diverse grief programs—including music therapy, nature-informed therapy, and integrative arts—innovation in bereavement care is becoming essential rather than optional.
Balancing Traditional and Innovative Approaches
The introduction of gamified approaches like Blue Ridge Hospice’s “Adventures in Grief” program doesn’t replace traditional bereavement support but rather complements it, creating a more comprehensive continuum of care that can reach more people in meaningful ways.
Finding the right balance involves:
Recognizing the continued value of traditional approaches while acknowledging their limitations for certain populations, particularly adolescents and young adults
Integrating evidence-based practices from established grief therapy with innovative elements that increase engagement
Offering multiple pathways to healing that allow individuals to choose approaches that resonate with their personal preferences and needs
Maintaining clinical expertise while embracing creativity, as demonstrated by Blue Ridge Hospice’s partnership between social worker Tina Thomas and Dr. Elizabeth Kilmer from Save Point Behavioral Health
This balanced approach recognizes that different individuals process grief differently. While some may benefit from traditional counseling, others—particularly young people—may find healing more accessible through creative, interactive experiences that provide psychological safety through symbolic distance.
Comparison of approaches and their benefits:
Approach
Key Benefits
Best For
Traditional counseling
Direct emotional processing, structured support
Those comfortable with verbal expression
Support groups
Shared experiences, reduced isolation
Those seeking connection with others in similar situations
Tabletop role-playing
Emotional expression through characters, engagement through play
Adolescents, young adults, those resistant to traditional therapy
Arts-based therapy
Non-verbal expression, symbolic processing
Children, those who process emotions visually or kinesthetically
Nature-informed therapy
Connection to natural world, sensory engagement
Those who find comfort in outdoor settings
The Promise of Play in Healing Journeys
The incorporation of play into bereavement support, as exemplified by Blue Ridge Hospice’s program, taps into a fundamental human capacity that offers unique benefits for healing from loss. Research increasingly shows that play isn’t just for children—it offers powerful therapeutic benefits for people of all ages navigating grief.
The healing power of play in grief work:
Creates psychological safety by providing emotional distance that makes processing difficult feelings more manageable
Facilitates symbolic expression of complex emotions that might be difficult to verbalize directly
Restores a sense of agency and control in a situation where people often feel powerless
Builds connections between participants, reducing the isolation that frequently accompanies grief
Allows for moments of joy without guilt, recognizing that healing includes reclaiming the capacity for positive emotions
As one theological perspective notes, play can be understood as a practice of hope in a context of pain. Through play, grieving individuals can experience moments of freedom from the weight of their grief, creating space for new possibilities to emerge.
The “Adventures in Grief” program recognizes that tabletop role-playing games offer a particularly powerful form of therapeutic play. As Susana Calley, director of the Blue Ridge Hospice Center for Hope & Healing, described it, the program represents “a powerful convergence of creativity and therapeutic support” for grieving youth.
Embracing the Future of Bereavement Support
As we look to the future of bereavement care, the success of Blue Ridge Hospice’s innovative program—supported by a substantial $340,000 grant from the New York Life Foundation and being tested across seven partner organizations nationwide—points to the growing recognition that creative approaches have an essential role to play.
For hospice professionals, caregivers, and family members, this evolution in bereavement support offers new hope and possibilities. By embracing both traditional wisdom and innovative approaches, we can create more effective, engaging pathways to healing for all who are grieving.
The journey through grief is never easy, but with creative innovations like therapeutic gaming alongside traditional support methods, we can offer more comprehensive, personalized care that meets people where they are and accompanies them compassionately through their healing journey.
