Volunteers in Chaplaincy: Doing What?

I ended my last reflection on volunteers with the question, “So, what can volunteers do?” For those of us who do call for a high level of quality of care for patients in health care institutions, that is not a simple question. I have suggested that there are a variety of qualifications that we might consider for a person who wishes to volunteer. But, as I have noted, the variety of qualifications simply begs the question.

Or, perhaps it only appears to do so. I say that because the variety of qualifications suggests that volunteers can do what they’re asked to do and trained to do. That is, there are people out there, and perhaps available, who have one or more of the various qualifications I suggested. Granted, there will be more un- or underemployed folks with CPE who might volunteer in major metropolitan areas. I have a colleague who has a Board Certified Chaplain serving on a volunteer (unpaid) basis. However, the other sorts of preparation I mentioned, from seminary courses to education programs for lay ministry, are widely available, and may well reach into small towns. We speak of folks as “volunteers” because we’re not prepared to pay for their service. But that in and of itself doesn’t describe the limits of what a given volunteer, with certain individual talents and preparation, might be able to do. Rather, it clarifies the question from “What can volunteers do?” to “What do we want volunteers to do?”

Two responses, one to the original article and another to the last post, can illustrate this. Barbara Jackman, a Board Certified Chaplain, wrote in response to the PlainViews article, “I've worked too often with volunteers who mean well, but simply don't have the training in communicating, in working with those of other faiths/cultures, or with those in crisis. At times that simply has given chaplaincy a bad name, and affects all of us.” David Fleenor, who has recently entered CPE supervisory training, responded to my last post with reflections from four years working in a hospital as a Patient Representative. His department considered and decided not to use volunteers, even to make initial visits simply to inform patients of the availability of the service.

The reason we decided against using volunteers for this was b/c often during the initial visit the patient would reveal a concern that required immediate attention.

You can see the parallels to chaplaincy. Volunteers might be useful to make initial visits, but what if an immediate need arises that require the sensitivity and pastoral skills of a trained chaplain? The volunteer could make a referral. That is not optimal, however, b/c of the golden moment when a patient takes the risk and finds the courage to reveal his/her anxiety, dilemma, etc. It seems less than a best practice for a volunteer to be in a situation where he says, "You have raised a very important issue. Let me make the chaplain aware of that so she can visit you within the next 24 hours." I guess one could counter all of this by asserting that the chaplain would never know of the patient's need for a chaplain had the volunteer not made an initial visit.

Nevertheless, as a Patient Representative department we were not willing to take the risk of putting an untrained* (unqualified?) person in the situation to deal with what we believed were issues that required our skills.

Both clarify that the issue to be discussed is precisely what we might expect volunteers to do.

And that is a more complex question. The answer will have to be individual to the institution and to the chaplain in the institution. There is a certain level of function that we through our professional organizations have identified with professional practice. That level of function is articulated in the standards for certification of our various professional certifying bodies. While the words and titles are not identical in all our organizations, I believe there are some consistent characteristics described:

• the capacity to establish and interact in a pastoral relationship based in active listening;
• to be able to develop that relationship across lines of faith and culture while respecting the faith and culture of the person served;
• to determine from that interaction a pastoral assessment or diagnosis, and to develop an appropriate plan for spiritual care;
• to educate other professionals as well as patients about spiritual care and about ethics;
• to administer a program of spiritual care, and to participate in the administration of the institution in which one serves;
• to represent in our practice, and to represent our practice to, the faith communities in which we are grounded.

(If I’ve missed something significant I know I can depend on my chaplain colleagues to call it to my attention.)

As I suggested in my PlainViews article, there are many parts of this that we can’t delegate. After all, I can’t delegate doing my budget or orienting new staff to the program. More to the point, I can’t leave it to another to determine a pastoral assessment or care plan. The capacity to function as a professional among other professionals in the institution is a major part of our training. However, it is arrogant to suggest that only we can listen sensitively and establish a relationship, or contribute information toward the assessment. Colleagues Barbara and David have valid points: persons poorly trained and/or poorly supervised can do harm, both to the patient, and to the reputation of the spiritual care program. But if we are Advanced Practice Ministers, as I want to suggest, we are prepared and called to take responsibility for that training and supervision, and for the careful screening that is implicit in it.

I appreciate David's comments regarding "missing the golden moment." I also appreciate his recognition that a referral and delayed response to an issue may be preferable to no response at all. In his comments he makes some comment regarding "legal issues." While always seen as a patient service, patient advocacy and representation are often perceived to have a link to risk management that we in chaplaincy do not share (and that could be the topic of another post). From that perspective, a case not handled may well create less risk than a case mishandled. I would question, though, whether we would share that perspective. Pastoral relationships are not established to solve problems. Generally, pastoral issues may change in intensity but will not change in form with some delay. Moreover, we can address with training the ability of a volunteer to determine urgency and decide just how soon that referral needs to be addressed.

I also think we can fall into an “expertism” about our practice that overlooks or denigrates the importance in pastoral care of simple presence. As an Episcopalian I speak regularly of the importance of “sacramental presence,” God’s capacity to work through material means, including us. Those who would not use sacramental presence would still appreciate the importance of the community of faith, and of the “ambassador for Christ” to represent the faithful concern of that community simply by being there. And any of us can appreciate the existential crisis of isolation, so exacerbated during an institutional admission, which is broken simply by the interest of another in reaching out to us. As I have said before, it has been my experience that people of faith appreciate the concern of people of faith, even if they do not share the same faith. A volunteer with sufficient training to do no harm can in fact often to good simply by being present and interested.

This is a lesson we can learn from our colleagues in congregations. Many of them have seen their role primarily as empowering and overseeing the ministries of others, and not trying to do everything themselves. Many have developed parish visitation programs, reflecting that the call to visit the sick with the love of Christ and the support of the community is a call to all Christians, and not simply to a professional class. As in our practice, they do not want their visitors to assess or treat. Rather, they reflect the love of the faithful; and any information that indicates need for further discussion is faithfully reported. The pastor then has the opportunity to function as pastor or confessor or director, as the situation warrants. So, we have the opportunity to educate and supervise to enable the ministries of others.

I have put this in explicitly Christian language because it is the language that comes to me most readily. I am, after all, an Episcopal chaplain, whether at the bedside or elsewhere. However, I believe this concept will translate well: that representative believers can help us, under our supervision and with our guidance, to demonstrate a caring and compassionate community within our institutions. They cannot do everything, any more than (to follow my PlainViews article) a Certified Nurse Aid can function as a Registered Nurse. They can, however, be present at times and places when the simple limitations of space and time prevent us. They can free us, too, to provide other kinds of care for which we are specifically qualified. If we so “expertize” our practice of pastoral care that we fail to consider how we might enable and support the vocations of others, all suffer: the volunteer stifled from sharing a charism, the chaplain frustrated and exhausted at what couldn’t get done, and the patient who did not experience the representative presence of the community of faith.

Keep watching. There is still more on this to come.