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.