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Friday
Apr242015

Getting to One Voice in Professional Health Care Chaplaincy

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:

 

  1. 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?
  2. What does our best evidence suggest are interventions that promote these desired outcomes?
  3. What competencies do chaplains need to deliver these interventions with maximum effectiveness?
  4. 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. 

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Reader Comments (3)

George:
Wow! Exceptional post, thank you for tackling the elephant in the room!

For many years now, long before we even met, I wondered about the clinical chaplaincy training and certification process. As a clinician, being an RN for many years before ministry, I was troubled when I was talking with CPE (ACPE) Residents, they lacked what I considered was even basic understanding of medical terminology, how to understand a disease process, and how to communicate what they do to other clinicians. The good news was they seemed to be processing some of their own issues that could impede relating to patients, families, and staff.

Right about the time we met, 2006(?), I was Director of a Pastoral Care Department with a CPE (ACPE) Residency program. The ‘CEO’ (MD who worked Administratively, Clinically, and in Academe) of the hospital was a staunch believer in education. As such he wanted ALL, emphasis on ALL, of his Resident, regardless of discipline to complete a research project before graduation. I’ll save the gory details but what happened was the CPE Residents were expected to know basic medical terminology (An on-line course was available), use their issued medical dictionary, be able to discuss the basics of the medical process, and complete a clinically specific project (Early on they were given several introductory lessons on basic clinical research. The projects were read by the CEO). In the end I thought that the program produced a better rounded clinician. This process went on for a couple years, then CEO and I both left.

My own CPE (ACPE) Residency helped me tremendously to transition from executive ministry back to clinical ministry. But unless I had the prior clinical background I would have been lost for the lack of what I’d identified earlier: basic understanding of medical terminology, how to understand a disease process, and how to communicate what they do to other clinicians. Last year I passed the BCC interview. Although I found attachments to my CPE experience, the BCC process seemed detached from the CPE experience. Often when working the BCC package I wondered, does APC-BCCI and ACPE even talk to each other? There seemed to be a disconnect between the organizations! Shouldn’t the criteria in my APC-BCCI package have had direct connection to the ACPE curriculum?

Up until last year I was credentialed with AAPC. When I recall the Pastoral Counseling training process (MA in Pastoral Care & Counseling) and board certification I see alignment. That which I was trained for, that which I was called to apply, and that which I was evaluated on; all aligned.

I really appreciate you opening up this topic. It’s past time for the various factions to come together, swallow pride, and begin discussion on bringing together the best of Professional Chaplaincy into one package!

See you in Louisville!
david

May 11, 2015 | Unregistered CommenterDavid Girardin

George, I do see your point. I have also advocated for conversation, not least from the perspective of a leader in my denomination, which has members in all three organizations.

Among my reactions to your comments: first, we need to consider the broad value of clinical pastoral education. It is certainly sine qua non for clinical chaplains. On the other hand, most of those trained in CPE are never going to be clinical chaplains. I have long felt CPE is as important, and perhaps more important, for its benefit in better preparing community clergy to provide care in their own settings. In a climate when the cure of souls is still too often doctrinaire, a "relational bootcamp" of CPE can significantly raise the bottom of the care available to our siblings outside of hospitals. We might need two tracks for CPE; but we need better to live into what we've claimed for a long time, that CPE is training in ministry, and not solely preparation for clinical ministry.

We need more research, I think, in what patients and potential patients want for their spiritual care. The research at Mayo is very helpful, even if it challenges some of our professional assumptions. I think we need more of that, especially as we see a rising number of folks tagged as "Nones" or "Unaffiliated," but who in fact have values, values they describe in terms we might call religious, but who, being "institution shy" have no community resource. What might they see as supporting their spiritual needs in crisis, and how might the interventions they choose contribute to physical and emotional wellbeing?

June 9, 2015 | Unregistered CommenterMarshall Scott

nice post. make me keep thinking about it

August 10, 2015 | Unregistered Commenterelena

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