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 and 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.

Tuesday, March 01, 2016

Faith Leaders and the Ebola Epidemic in Africa

If you're not on the list to receive headlines from the Anglican Communion News Service or the Episcopal News Service, you may have missed this (it was circulated by both services). Three bishops of Anglican dioceses in west Africa recently visited England where they spoke both to the Anglican Alliance and to General Synod about the church's response to and participation in the efforts against ebola in the recent epidemic. At the link above there is information about their meeting with Anglican Alliance, and also other information about responding to ebola.

One of the resources there that I found especially interesting was Keeping the Faith: The Role of Faith Leaders in the Ebola Response. This publication of Christian Aid is worth reviewing. It reports a study describing how religious leaders, both Christian and Muslim, were critical in gathering community support and convincing anxious communities to accept medical assistance. While the document is quite long, the Executive Summary, beginning on page 8, describes the findings well. Initially, some communities feared the government intervention as much as the disease. After disease had struck a village or a family, there was significant stigma. Initially, the medical workers were not interested in participation from faith leaders. However, once engaged, faith leaders were able to provide educators whose authority was accepted to help communities understand the disease and the necessary help. They were also able to provide support for disrupted families and communities, and to address directly the issues of stigma.

We were anxious in the United States about ebola, even though the risks to the population as a whole were small and manageable. This report speaks from the center of the outbreak, where risks were great and resources for control thin. It's helpful to see how faith leaders, with their established authority in their communities, were able to take the lead in providing care for prevention, treatment, and community need. I hope you'll take time to at least read the Executive Summary.

Friday, February 05, 2016

On Days and Numbering and Other Things

Regular readers know that I am an occasional contributor to the Episcopal Cafe, so it won't surprise anyone that I am a daily reader. This morning, I followed this post, Bishop Katherine Jefferts-Schori contributing to the series on Faith and Science in the 21st Century at Day1, the radio and on-line resource supported by mainline Protestant churches. I certainly commend Bishop Jefferts-Schori's video and her reflection on re-framing and repentance.

And then, looking further in that series, I discovered another contribution: the Rev. Dr. Tom Long reflecting on Psalm 90 and the call to Number Our Days. I was especially interested because the point of his sermon (on the link, and then scroll down past the interview portion. If you're registered with Day1 you can hear the audio of the sermon.) was to reflect on numbering our days in light of the capacities of contemporary medicine. He speaks to a difficulty that I have described by saying, "When will folks understand that Dr. House lied to them? We don't get every patient cured, much less in 60 minutes!" Tom Long points this out himself, if more gently, and reflects on numbering our days and wisdom.

Often enough I have spoken to this myself, frequently addressing (all right, complaining about) the tendency in the media to hype every small study with an apparently positive result, without presenting that result in its longer - and not necessarily so positive - context. Tom Long does it with a bit more grace and a bit more Scripture, and I commend this to you, too.

Wednesday, January 27, 2016

Extending God's Party: Sermon for Epiphany 3, year C

I had the pleasure of preaching again at St.Mary Magdalene Church in Belton, Missouri (or, yes, Loch Lloyd). You can link to the sermon here.

Just one explanatory note: I also preached there on Sunday the 17th, and, reflecting on Jesus at the wedding at Cana, spoke of God's party, the celebration and celebrating we do that demonstrates the presence of Christ in the world. So, if you're not sure what "party" I mention in the sermon, there it is. God calls us to celebrate by demonstrating God's presence in Christ; and to use all our gifts for the party; and to invite to the party those who most need to hear about the Year of the Lord's Favor.

Tuesday, January 19, 2016

We're Here to Help

I do still look up health news now and again, considering topics of interest. And, this evening I ran across this story from ABC News.

The headline captures the point well: “Many Doctors Choose End-of-Life Care Differently Than the General Population, Two Studies Show.” In fact the two studies appeared today in JAMA. the Journal of the American Medical Association. You can review them here and here. The points are that doctors are less likely than the general public to die in a hospital, or to use medical procedures and technology at the end of life. Both studies are based on the medical records of literally hundreds of thousands of people, and as we all know, those large numbers mean statistically meaningful results.

Perhaps this would be a surprise to someone, but not to those of us who work in healthcare. Indeed, the second study looked at folks who worked in healthcare who were not doctors; and their results were closer to the doctors than to the general public. The comment in the article is that the general public isn’t prepared to discuss what the limits might be to appropriate care. I think we need to respect the other side of that coin: those of us who work with it every day are more likely to discuss it, precisely because we have seen what those hospital stays and late life interventions do – and don’t -  accomplish.

I don’t want to press these results too far. While the differences are statistically significant, they aren’t absolute. In fact, a lot of those late life interventions in hospitals happen before the decision is reached that it is in fact the end of life. And, of course, there are certainly enough doctors who also have difficulty talking about decisions at the end of life – their own lives and those of their patients.

At the same time, perhaps the opportunity is for folks who don’t work in healthcare to ask those of us who do, whether doctors or not. It would be even better if they were to ask us especially when it isn’t a crisis. I have said often enough that these topics should be discussed over breakfast at home; and that the worst place to discuss the patient’s wishes is at a bedside in ICU at 2:00 in the morning.

So, perhaps the ABC News article can stimulate more of these conversations. It is a bit easier to have these conversations with one’s physician these days, but you don’t have to wait for that annual appointment. Perhaps it would be better to have the conversation with friends and family, especially (but not limited to) any who work in healthcare. We know the stakes. We want to help. And if it does get to 2:00 in the morning at a bedside in ICU, it’s likely to be those family and friends who get asked just what your values would be.