After my recent talk at HCCN’s Caring for the Human Spirit Conference in Orlando, one of the questioners raised the issue of the long-time and oft-acrimonious splits within professional chaplaincy membership organizations. The issue focused especially on the rift between the College of Pastoral Supervision and Psychotherapy (CPSP) on one side and the Association of Professional Chaplains (APC) and the Association for Clinical Pastoral Education(ACPE) on the other. For those who may not be professional chaplains or who may be new to the profession, one of the great embarrassments in the profession (to me and many others) is our inability and/or unwillingness to have one organization that would speak for the profession- or even sometimes to get along among ourselves.
This questioner focused on the lack of reciprocal certification between CPSP and the other groups and within that, the lack of recognition by groups like APC of training by CPSP that would fulfill a requirement for certification. Currently those with only CPSP training cannot apply for certification in the APC. This issue is likely the one that is most apparent and troubling to the respective memberships and those preparing to be certified as chaplains.
While I had not thought a lot about this particular issue, it occurred to me that, rather than tinker with and try to reconcile the current systems of training and certification - which likely would just devolve into discussion about whose system is better - we should start over with the whole enterprise. Many of us have come to the conclusion in any case that the whole system of training and certification for health care chaplaincy is not reliably or demonstrably producing competent chaplains and needs a ground-up overhaul. And I say this as one of the people who led the effort that established Common Standards for Certification and as a former APC Certification Chair.
Further, I would suggest an approach that (1) seems more appropriate to the current way professionals do things in health care and (2) would help us operate with a clear slate because none of us have done it this way before. I would suggest proceeding as follows:
- The first premise is that everyone who wants to be at the table is welcome as long as they covenant to treat everyone else at the table with respect publicly and privately and agree that all past hurts and disagreements are past and not part of this process.
- The second premise is that (1) the relevance of any and every part of a new system will be evaluated only on the extent to which it brings benefit to patients, their caregivers and the health care system and (2) the patients, their caregivers and the system would have a voice in defining what constitutes “benefit” for them. The corollary of this premise is that no consideration would be given to any proposal whose primary purpose is to serve or preserve particular groups of chaplains, particular faith communities, or particular membership associations.
The process would seem to need to proceed in the following steps:
- Building consensus around outcomes, with the process requiring the inclusion of patients, caregivers, members of other health disciplines, health care leaders, payers, and policy makers. What are the benefits that chaplains do or could provide? What beneficial outcomes can be anticipated in the near and long term future?
- What does our best evidence suggest are interventions that promote these desired outcomes?
- What competencies do chaplains need to deliver these interventions with maximum effectiveness?
- What are the components of a system that would most reliably, efficiently, and fairly evaluate whether a given chaplain has these competencies? The evaluation system is going to be critical because this proposal does not require any particular prior training or assume that any kind or amount of prior training produces competence.
We have little or no evidence that the current system of training or certification of any of our associations produces chaplains who actually help people or support the deliver of good health care. We owe our patients and caregivers a better effort.