Key points from this morning’s keynote address at the Caring for the Human Spirit Conference by Michael Rabow MD FAAHPM – the Helen Diller Family Chair in Palliative Care, and a Professor of Clinical Medicine and Urology in the Division of General Internal Medicine, Department of Medicine, at the University of California, San Francisco.
How do you know when you are walking on spiritual ground? When you are dealing with a patient with spiritual distress struggling with a spiritual concern. Signs of spiritual distress: doing something they’ve never done before or not doing something they’ve always done; asking the dreaded questions in various ways: “why” and “how” that are difficult to address.
How MDs (who he primarily works with; can be applied to other disciplines) can respond: Learn how to bear another’s suffering by creating safe space, bearing witness through silence for an extra moment. Interventions: life review/dignity therapy, meaning therapy and support group, legacy work. Handling with care: making a referral to the chaplain to go deeper.
The 2018 Annual Conference of the Association of Certified Christian Chaplains will be held November 2-4 in Colorado Springs, Colorado. The annual three-day conference provides numerous sessions to bolster the knowledge and understanding of the work of Chaplaincy across a broad range of settings. In addition to conference sessions, time is built into the schedule to allow for networking, collaboration and encouragement of chaplains across the United States. Board Certification recognition will also be given to newly board certified Chaplains, Associate Chaplains and Chaplain Supervisors during the conference.
Conference sessions will be held at Focus on the Family Headquarters. To learn more and to make your conference registration, visit our Conference page located https://certifiedchaplains.org/annual-conference/ .
From the desk of
The President and Chief Executive Officer
HealthCare Chaplaincy Network
Spiritual Care Association
HealthCare Chaplaincy Network
Clinical Pastoral Education Program
January 4, 2018
In a speech1 given in April 2016, Rev. Eric J. Hall, President of HealthCare Chaplaincy Network (HCCN), announced the founding of its affiliate, the Spiritual Care Association (SCA). In doing so, he cited a strong demand signal from prominent leaders in the U.S. healthcare chaplaincy movement including Wendy Cadge, George Fitchett, Kevin Massey, and Alexander Tartaglia for major changes in the way healthcare chaplains are educated and the ways that education was evaluated, particularly in Clinical Pastoral Education (CPE)2,3,4. This announcement was followed by a more detailed white paper5, Time to Move Forward: Creating a New Model of Spiritual Care to Enhance the Delivery of Outcomes and Value in Health Care Settings, which presented and discussed the barriers impeding the full integration of spiritual care and chaplaincy care in health care and recommendations to remove them.
Rev. Hall’s 2016 observations on the lack of standardization and measurement of outcomes are not new. Acknowledged pioneers and later leaders of the clinical pastoral education movement have been calling for these changes for sixty years. As early as 1958, John Thomas called for the field to “better measure the effectiveness of clinical pastoral training so we have more objective standards”6. Some years later, Clark Aist wrote: ” Do we emphasize the self-development of the student for general ministry? Or do we focus on the acquisition of specific competencies for ministry that might be utilized in specialized settings? Should our educational programs themselves have built-in closure points or do the various types of certification offered by cognate groups offer a sufficient closing process? And what about the thorny issue of curriculum content? Not only how we teach, but what we teach.”
“Our subjective intuitions have by and large served us well in certification, but there is growing recognition of the need to make the process more objective and to more clearly specify the levels of knowledge and skill that the candidate must acquire.”7
The last year has brought a myriad of chaplains to the SCA asking how and when they can be reimbursed by payers including Medicare for the care they provide. Before they will reimburse for interventions, or include chaplaincy in a reimbursement model, any payer will surely require that the provider of such interventions demonstrate that they are delivering high-value quality care. This goal can only be successfully met when provider preparation, education, experience and clinical care competency are demonstrated in a standardized and measurable way. This demonstration and measurement is not possible in the historical method and model of professional chaplaincy training and certification that is still widely used.
This lack of standardization in order to demonstrate chaplain’s value and quality-based care is the most significant barrier currently facing the field of professional chaplaincy. However, it is an obstacle that is already being overcome through the work and contributions of the SCA. The current objective competency testing established and provided by the SCA shows significant deficiencies in knowledge and competency among current professional chaplains, including critical areas such as communication skills, HIPAA compliance, spiritual assessment and appropriate documentation among others.
Inadequacies such as these should not exist at all in chaplaincy and spiritual care and must be addressed across the profession. The SCA is the only organization in the U.S. that is actively working to address this to improve the knowledge, skills, competency, and evidence-based practice of chaplains.
HCCN constantly strives to move the field of healthcare chaplaincy forward, responding to the challenges posed by its past and present leaders, and improving the spiritual care of patients and caregivers. As soon as it was permitted by its accreditation, HCCN enthusiastically adopted and rolled out newly adopted standards that, for the first time, allowed for virtual CPE. This program has been tremendously successful from the students’ point of view as well as providing benefit to the patients and families to whom they provide care. As expected with any new effort, however, the standards and methods to meet them have raised concerns that need to be addressed to make them more effective in meeting educational standards, student needs, and the care of patients and families. To that end, HCCN has committed to address the shortcomings of the model for virtual CPE and better align all methods and settings of chaplaincy training with the current demands of U.S. health care for the benefit of both students and patients.
In order to achieve these goals, HCCN will transition its CPE program to the Institute for Clinical Pastoral Training (ICPT) as its accrediting body. ICPT has emerged as a creative and innovative organization within healthcare chaplaincy in the U.S. It has sought to implement many of the educational goals that chaplaincy leaders have called for and is committed to moving the field forward.
ICPT is a candidate to receive Department of Education accreditation. As the Spiritual Care Association is the only professional chaplaincy organization in the U.S. that has a program that includes evidence-based standardized curriculum, verified knowledge, and demonstrated competence, ICPT is working closely with SCA to incorporate these essential components into the traditional CPE experience of formation, self-growth, and group communication. In addition, ICPT and the SCA are exploring other standardizations including methods of spiritual assessment, documentation, taxonomy, interventions and other quality indicators essential to chaplaincy care. Most importantly, all students will participate in objective testing assuring core knowledge has been verified and the student is properly prepared to provide clinical care. This model is better quality, based on evidence, and will cost less for the student.
All who have been in the field of chaplaincy care or have had oversight of chaplaincy departments understand that the system of education, preparation, testing and certification is long overdue for this change. We support current systems because of what they are historically with a clear sense they are not what we need for the future. Numerous institutions unknowingly cite them as a requirement for training without the full knowledge of the inadequacies they present, while many of us have simply followed the path of what is and has been politically expedient. However, a new opportunity and challenge has now come requesting our attention.
Many institutions and individuals are now choosing to follow a new path and model of chaplaincy education which leads to professional certification that provides the highest quality and value of care delivery for patients, caregivers and health systems in every setting. The time to move forward without hesitation is now.
HealthCare Chaplaincy Network and the Spiritual Care Association have taken the steps required to be the leaders of change that the pioneers of chaplaincy and decades of leaders called and hoped for. We are committed to preparing and empowering chaplains to provide high value and quality spiritual care to patients.
Accordingly, effective as of June, 2018, allowing current students to fulfill what they have struggled and scheduled to do, HCCN CPE units will be accredited solely by the Institute for Clinical Pastoral Training.
1 President’s Speech. Caring for the Human Spirit® Conference. San Diego, California. April 11. 2016. http://bit.ly/2lPm95Q
2 Cadge W. Paging God: Religion in the Halls of Medicine. 2012. Chicago, IL. The University of Chicago Press. http://bit.ly/2lPm95Q
3 Massey K. Surfing through a Sea Change: The Coming Transformation of Chaplaincy Training. 2014. Reflective Practice: Formation and Supervision in Ministry. 34. 144-152. http://bit.ly/2CNkPYy
4 Fitchett G, Tartaglia A, Massey K, Jackson-Jordon B, Derrickson P. 2015. Education for Professional Chaplains: Should CertificationCompetencies Shape Curriculum? J HealthCare Chaplaincy. 21:4. http://bit.ly/2lQCvdB5 Time to Move Forward: Creating a New Model of Spiritual Care to Enhance the Delivery of Outcomes and Value in Health Care Settings. 2016. HealthCare Chaplaincy Network. http://bit.ly/2lSnsQy
6 Thomas J. Evaluations of Clinical Pastoral Training and “Part-Time” Training in a General Hospital. 1958. J Pastoral Care. 12:1. 28-38 http://bit.ly/2E2py85
7 Aist C. Standards: A View from the Past and Prospects for the Future. 1983. J Pastoral Care. 27:1. 6067. http://bit.ly/2E2py85
Christian Chaplains, who serve in a correctional setting, find themselves dealing with individuals from widely diverse backgrounds. Many cultures, languages, and belief systems are represented in the typical correctional population. Additionally, many incarcerated individuals exhibit non-rational and often criminal thinking patterns. The chaplain has to learn a new language, as it were, and be cautious in his/her dealings with those he/she serves.
The dynamics that drive these issues are profoundly complex and can become a seemingly insurmountable barrier to effective ministry. Additionally, the facility’s classification level and population demographics further rules out any “one size fits all” approach.
Through our clinical pastoral training, we learn that every individual we serve is unique. Anton Boisen taught that each person is a “living human document”. Each of these unique documents are written from a perspective peculiar to that individual, based on their worldview, experiences, education, and bias.
Incarcerated individuals typically think differently than members of the public. This is not a demeaning statement, merely an acknowledgment of the facts. Incarcerated individuals filter their thinking through a different set of ‘screens’ than most in the general public. These screens are frequently the result of deprivation, abuse, neglect, prejudice, and poverty among others. While this may not be true of all those who have been convicted of criminal conduct, it is a very common reality.
Chaplains must learn to read the documents before them with great clarity. Not everyone who seeks out the chaplain is looking for guidance or assistance. Some are doing so under the pretense of seeking help, when in fact they are seeking an opportunity to manipulate the chaplain, another staff member, or a volunteer. Therefore, discernment is profoundly critical.
The chaplain has to learn to balance the danger of being manipulated with the mission of pastoral care. This is not a balance easily achieved or maintained.
The tools acquired during one’s CPE training can make the difference in this situation. Carefully constructed open-ended questions and highly developed reflective listening skills can, and more often than not, reveal the motivation behind the request.
We never want to be guilty of rejecting someone’s plea for help or to fall prey to a well-constructed ploy. The safety and security of the facility at large and of those who work and live there are uncertain. Not everyone who is called to ministry is well suited to the correctional environment.
In a correctional setting, the chaplain generally has the luxury of time. Most requests can be responded to a bit later. This delay gives the chaplain an opportunity to do some homework about the individual inmate and the nature of his/her request. However, it is critical that delaying an answer is not perceived as a lack of compassion or interest. Again, asking the right questions is essential to gaining sufficient understanding of the situation to give the appropriate and timely response.
In this midst of this environment are men and women who long to be heard, who long for someone to express concern, compassion, mercy, and grace. Grace is the primary expression of God toward the children of humankind and ought to be the chief attribute of the chaplain. Not naiveté, but genuine godly compassion (i.e. grace).
The temptation for correctional chaplains is often driven by the “righting reflex”1 as Dr. William Miller calls it. We want to fix people. We understand that their thinking has produced a life style that is criminal. Thus, driven by criminal thinking, these men and women end up separated from their families and communities – locked away into something less than the position human beings ought to occupy.
The idea that we can diagnosis the root cause of criminal behavior and provide a simple fix is a bit over optimistic, perhaps short sighted. Long-term chaplains have grown to understand the process of change is slow. It requires first that the person with whom we are working recognize, for themselves, that the mindset they hold is more of a prison that the physical structure in which they reside. Without this recognition, change cannot take place. In that all change is “self-change”, it is an acknowledgement that change is needed is the necessary starting point.
Most offenders are slow to consider that there is something wrong with their lives. Most, not all, hold to the idea that they are victims of a society that dislikes or even hates them for some reason or another. Many will say, “I grew up on the wrong side of the tracks.” The idea that something external to themselves lay at the root of their incarceration is all too common. Holding a victim responsible, in the inmate’s mind, is quite common. In addition, culturally, this concept has gained considerable footing in the United States and our communities. It is no surprise then that this way of thinking is common among those incarcerated.
Paul writes in Romans 13: “Let every person be subject to the governing authorities. For there is no authority except from God, and those that exist have been instituted by God. Therefore whoever resists the authorities resists what God has appointed, and those who resist will incur judgment.”
Simply put, most of those who are incarcerated have a history of demonstrated difficulty with authority. The sin of the Garden was a rejection of God’s authority—and all sin since that time has its roots in the rejection of God’s authority.
The correctional chaplain has to illustrate an unwavering subjection to the proper authorities both in the community and in the institution. This “living out the faith” is vital to leading by example; as a man/woman in subjection to God’s authority and thus the authorities that He Himself has instituted. This might be understood better if we equate it to walking a tight rope… with a significant drop beneath.
From the Christian perspective, the problem is what the Bible calls “sin.” C.K. Chesterton wrote, “The ancient masters of religion… began with the fact of sin – a fact as practical as potatoes.”2 It is sin, common to all men that lay behind the motivation to misuse and/or take advantage of others. Sin, not poverty, or similar issues lay at the root of criminal behavior. Perhaps it is the sin of the fathers or mothers, but sin nonetheless. Yet, much like an undiscovered cancer, it cannot be addressed until there is the recognition that it exists.
Clemente, Norcross, and Prochaska, in their trans-theoretical model of change argue that many who are in need of change are pre-contemplative, that is, they see no need for change.3 Such is the mind and heart of a man or women committed to sin. The life of sin is addictive… in many respects attractive and easily justified in our own minds.
As a chaplain in a correctional setting, you are dealing not with merely momentary challenges or crises in the minds and lives of those you serve – but with long-term issues that began months or perhaps years before you met this poor soul and will not be remedied with a sudden application of grace. That change may well come (and God is able to bring it to fruition instantly), but in my experience, rarely does it occur quickly. It is then a process more often than not. A process that begins when the chaplain, using every skill and grace granted him/her, extends the hand of God’s grace to that incarcerated soul.
CPE then, within the confines of a correctional facility, leads us to come along beside the incarcerated individual and journey with him/her toward the possibility of a new life… a life filled with hope and promise rather than one caught in the cycle of crime and imprisonment.
Self-awareness is an essential mindset for the correctional chaplain. We must recognize the baggage we carry along and know how of keep the skeletons of our past from interfering with the ministry of the present. CPE teaches us to be self-aware.
Self-awareness gives us the insights to keep our personal prejudices at bay and thus to be transparent with those we serve – no matter what their beliefs, crimes, or attitudes.
Self-awareness helps us recognize our own venerability to “the sin which so easily entangles us” (Hebrews 12:1b NAS95), and thus understand, as we look in the face of our incarcerated client; “but for the grace of God there go I” .4 Self-awareness produces genuine humility, a necessary attribute for the correctional chaplain.
In short, taking advantage of clinical pastoral training equips us to be more effective as chaplains in a most difficult environment. Balancing the roles of “pastoral care” and “corrections professional” requires every advantage you can get. CPE goes a long way to meeting that goal.
1The Righting Reflex, Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing) by William R. Miller, Stephen Rollick (location 204, Kindle edition)
2Orthodoxy, C.K. Chesterton, William Clowes and Sons, Limited, London; 1908 p.5
3Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward by James O. Prochaska, John C. Norcross, PhD Carlo C. DiClemente.
4Attributed to 16th Century English reformer John Bradford prior to his martyr’s death at the hands of Bloody Mary. Bradford was burned at the stake.
Tim O’Dell is a prison chaplain with the Corrections Corporation of America and a Board Certified Chaplain and Supervisor-in-Training with ACCC.
Copyright © 2016 R. Tim O’Dell. Used with permission.