Thursday, June 30, 2016

Another Chaplain Voice in the Blogosphere

Any regular readers know that I'm always attentive to any new chaplain voices that pop up in the blogosphere. In this case, it's not that this person has just popped up. However, she's just come to my attention. She's actually been blogging longer than I have.

The name of the blog is Diary of a Contemplative. The Blogger is Amy Kumm-Hanson, an ELCA Chaplain. As I notes, she's been out here longer than I have (although not nearly so long as a chaplain). So, for those of us in the business - or just interested in the business - give her work a look.

Thursday, June 23, 2016

Further Considerations: More Reflections on "Testing the Efficacy of Chaplaincy Care"

So, I’m still in the process of thinking about Literature Review - Testing the Efficacy of Chaplaincy Care. This particular post isn’t really critique, but some thoughts.

One point to appreciate about the report is an entire section on “Limitation of Scope” (pp. 11 forward). The authors are discrete in describing what they are doing, and a clear sense of what they can and can’t do. For good reasons (again, it’s worth reading, so you can look at these yourselves) they note that they are looking at the North American environment for chaplains, and at acute care settings. They note specifically that “A review of the extensive literature on the influence of spirituality and religion on health is beyond the scope of this report.” (p. 12)

It seems to me that this highlights a theme in the report: to emphasize the research on chaplaincy specifically, and especially that done by and/or for chaplains.  It is an arguable approach. I can see the point, but it also misses a point. One of my concerns has been that we don’t read other professions’ research.

This is a comment I have made before, but I think it worth making again, and especially in considering this report on research that can guide and benefit chaplaincy. Research that speaks to spirituality, and so to the area of expertise of chaplains, appears in journals of a variety of professions. A review of the bibliography that the report includes demonstrates that to some extent. However, as the report focuses on chaplaincy specifically it doesn’t give a clear idea of the breadth of research to consider, whether in medical, nursing, psychology, or social work journals.

Now, I have noted that some of that research isn’t all that helpful (although I believe profoundly we need to be responding to it for that reason.) On the other hand, some of it is. We need to be reading it to see what our professional colleagues might be seeing, and to see what might be useful for us.

We need also to attend to the research on the correlation between religious behavior and health. The authors of this report allude to that work. They also note that there is criticism of that work. It often is hard to address the mechanism: that is, to identify the causative factor that brings the correlation about. While this is legitimate, I believe it overlooks the perspective of the individual patient that the motivation or association or affiliation that contributes to the result is religious. While not specifically about chaplaincy (and not always necessarily helpful for chaplaincy) it is research we need to be conversant about.  

I would also note that there is a good deal of research now to describe the current religious and spiritual landscape in the United States (and perhaps more broadly in North America). Most of this has been done for faith communities, most of them Christian, who want it to help focus evangelism. Evangelism is specifically not an interest of chaplains. However, the religious and spiritual landscape is very important for us. That includes both some sense of how people are affiliated, and also some sense of the spiritual lives of those who are not affiliated. One of my touchpoints with my own administrators is that with the growing number of folks who are indeed spiritual (expressed in familiar terms) but not religious (in the sense of being part of an institution) there is greater need for chaplains. We are those best prepared to support those with spiritual needs and no outside professionals to call on.

The authors are correct that chaplains need to be doing research to better describe and guide our work. We also need to be reading other professions’ research, whether it seems applicable initially or not. A report comparable to this that gave some review of where else we might be reading, and what we might want to recognize, appropriate, or challenge in the research of other groups would also be a valuable contribution.

Sunday, June 19, 2016

Credit Where Credit Is Due

The Healthcare Chaplaincy Network (HCCN) has disturbed the chaplaincy profession with the decision to establish the Spiritual Care Association (SCA). While I don't think it was necessary, my position is basically that of Gamaliel in the Acts of the Apostles. I plan not to say too much about it, and trust in God. If it brings benefits it will stand. If it doesn't, it will fail without help from anyone else.

With all the criticism, though, of HCCN for starting a new organization, I think there is some point in appreciating other things that they have contributed. They have provided support for a number of projects. They have been especially interested in research. HCCN leadership has felt that, to the extent possible, the profession should be evidence-based, and research is how we get the evidence.

With that in mind, I want to commend their document, Literature Review - Testing the Efficacy of Chaplaincy Care. It is well worth reviewing.

Not that I'm going to do that here - at least, not in full. The document is 88 pages, with a great deal of information to digest. So, I'm not going to do   single review of the entire piece. I am, however, going to look at some interesting parts of it.

I am going to recommend that we all read the first section of the paper, the Executive Summary. There is plenty of information there to consider. There is a summary review of chaplaincy in healthcare, and an argument that chaplaincy should be research-based.

Also helpful, and especially helpful to include in the Executive Summary is Gap Analysis, a list of areas for research that would benefit the profession. The list itself is both exciting and appalling: it is both excitingly thorough and depressingly long. We have a lot of work to think about doing.

I happen to agree that our profession can and should do research. However, my concern is that we're not doing research that could benefit us. As the Executive Summary states,

Since chaplaincy research has only begun to accumulate, there is a significant danger that research will not proceed in a focused and organized manner.   

We're not alone in that. In this recent story on NPR it was observed that in many fields that's an issue. There is excitement over the new and groundbreaking, but not much over confirming (or disproving) something already started.

For chaplains, at least, this has resulted in a host of small studies, essentially pilot studies that demonstrate (if they demonstrate anything) that a subject can be studied, and that perhaps there is value in studying it again. And if no one actually studies it again, the potential value is lost. So, the authors point out,

If study questions, methods and outcomes are carefully chosen they will build upon and integrate with other work in the field of spiritual care.  One way to support a focused research agenda is to fund research through one or more central consortia, which would set the research agenda, fund studies through a Request for Proposals process, and promote communication and capacity building among the research groups. The consortium would be advised by clinical and research leaders in chaplaincy who would set the basic parameters of the research, monitor its progress, and serve as mentors to new researchers.

This is certainly an issue that the professional organizations, and larger chaplaincy institutions (like HCCN) might take up, whether individually or as part of a proposed consortium: choosing topics for study, or replicating worthwhile pilot studies, on a large, even multicenter scale. We might even be able to leverage recent changes in healthcare in general to support that. For example, a number of centers using the same electronic medical record platform might add specific pieces to their documentation. That would allow consistency and ease of access to the data across a variety of institutions. Such a proposed consortium, or even a single body adept at coordination and grant writing, could help make these meaningful steps.

The paper, Literature Review - Testing the Efficacy of Chaplaincy Care, from HCCN is a significant contribution to the field, one that many may have missed. I think all of us should review at least the Executive Summary. Those of us with a more active interest in research should dig further (and, after all, for those of us whose continuing education requirements include some focus on research, there are several contact hours to be acquired here, covering the good work). While HCCN has become a center of controversy, we also do not want to ignore their important contributions, including this one.

Tuesday, May 31, 2016

A Quick Note: AEHC in Orlando This Year

All right, siblings, here is the news: we have the schedule for AEHC events at this year's APC Conference in Orlando. All events are scheduled for Friday, June 24th (the Feast of the Nativity of John the Baptist!):
  • Eucharist 7:00 am
  • Breakfast/meeting 8:00 am Palm Ballroom 1
  • Reception outside Pavilion 6:00-7:30 pm- appetizers and cash bar.
The registration fee for this year's events will be $100.00, to include both breakfast and the reception. So, get the word out!
As soon as a registration form is available, it should be posted at the AEHC Facebook page.

Friday, April 15, 2016

Whither Chaplaincy? Looking at the Spiritual Care Association

The newest event in the profession of healthcare chaplaincy has been the announcement by the Health Care Chaplaincy Network (HCCN) by a broad new initiative centered in the Spiritual Care Association (SCA). SCA will encompass a new professional organization, new standards for Board Certification (without rejecting existing standards for other professional organizations), and new opportunities (that may also mean new standards) for clinical pastoral education (CPE). There has been a good deal of conversation on this on the Facebook page of the Association of Professional Chaplains, and I’ve made my contribution. With that in mind, I thought I would also share my observations here.

Let me say, though, that to make sense of these observations, you need to look at the SCA website. Review the plans for Membership, for Certification and for CPE, and see for yourself what you think.

This conversation began when I asked on Facebook about the need for a new spiritual care organization and its multiple initiatives, I took the time to watch the video of Eric Hall introducing the Spiritual Care Association at HCCN's Caring for the Human Spirit conference. It addresses the questions I raised. Some things in it I find compelling and some things I don't; but it's well worth the 45 minutes to watch. To contribute to the discussion we've started below, or to respond to me now, go first and watch the video. We can then talk more about how we react.

First, I found some of the criticism of the existing organizations apt, and some inappropriate. I agree that things haven't moved as quickly as I might like - matters like settling on a limited number of spiritual assessment models, or developing the Standards of Practice. At the same time, It simply is easier for a business enterprise (non-profit, certainly, but structured as a business) to act, and develop a membership organization as justification, than it is for a membership organization, working almost entirely with volunteer "employees," to develop the structures to act like a business; much less to develop collaborative structures with other collegial membership organizations. HCCN has been quite successful over the years at pursuing philanthropic funds. I wish APC had been as successful. I wonder if there wasn't some loss due to the competition.

Beyond that, where to start? Let me start with thoughts about a different set of educational standards. What Hall describes in his address is a clinical education curriculum that is much more content-focused and content-driven than clinical pastoral education as we know it. That was, I think, somewhat more the case with the NACC CPE programs, because they had clear expectations of formation not just as chaplains but as Roman Catholic professionals. I grant that CPE curricula are not standardized; but in general they have been oriented toward formation of the individual vocations rather than a specific content. To move the focus from personal growth toward content transmission would be a significant change. (Enough for the first comment.)

There is a distinct movement within the entire SCA panorama to identify and focus on the spiritual as separate from the religious. Evidence for this is the lack of extensive theological education or ecclesiastical endorsement for certification. This concerns me for several reasons. First, it remains the case, at least in these United States, that most persons express their spirituality in language we would call religious, even if they are not members of institutions. Indeed, those who have done research on Nones or Unaffiliated (depending on your research) found that more than 70% of them had values that shaped their lives and decisions, that they commonly expressed in language we would call religious.

A second concern would be how we identify the spiritual separate from the religious. In our house we have a long history of saying, "The mystics all have the same experience, and then describe them differently due to the inadequacy of human language and culture." We might try a reductionist process to identify what is spiritual, derived from what is religious; and then how would we talk about it? The HCCN/SCA effort would want to focus on something like this at the core of a coherent body of knowledge; but I'm not sure the effort would yield meaningful results, or results that would translate to our patients, families, and staff.

Another concern related to the spiritual/religious divide is the loss of accountability to a faith community. We have long understood ecclesiastical endorsement as something of a "patient safety" matter: it is another avenue of accountability, another resource to address questionable practice. In the presentation, and also in the information on the HCCN/SCA web site, this is simply absent. It would be important to hear explicitly why this is not still helpful to our consumers.

That is not too far from my own experience. In my years as a chaplain in healthcare - virtually all of my career - I have certainly understood that I needed to understand and participate in the culture of healthcare. I am committed to research, both doing our own and reading and understanding the research of others. I am committed to communicating well what our value is. I am also convinced that the team, from doctor to nurse to administrator to HR to... well, to all of them, that the team does not want me to be more clinical at the loss of what the team understands as spiritual, which quite clearly includes the religious. The team wants us to be spiritual providers - clinically informed, yes; but definitely distinctive.

These are the thoughts I started with. There will be more.  The conversation will continue on Facebook. There should also be a feedback page coming to the SCA site, so the conversation can happen there. Dig in.