Still Becoming an Episcopal Chaplain

 While I’ve been pretty slow in postíng in this strange and difficult year, I know some folks are still looking for my posts on becoming an Episcopal chaplain. With that in mind, our friends at the Episcopal Church Center want to be sure we have the best link to open the Application for Ecclesiastical Endorsement. The best current link is here. I’ve also shared this in Facebook and have updated the link at our website, Assembly of Episcopal Healthcare Chaplains.

And, if you have found your way here searching about becoming an Episcopal healthcare chaplain, those are also good resources. There is the AEHC Facebook page, and information on our website, including a flowchart about the process. You can contact me to ask for help, or contact AEHC from the web site, or find a connection on Facebook. We’re happy to provide information and support your process.

Ecclesiastical Endorsement in the Episcopal Church, 2019

As I have of late, this is also posted at Chaplair, the blog of the Assembly of Episcopal Healthcare Chaplains.

I’ve written before about ecclesiastical endorsement in the Episcopal Church. I have been through our process, and I have been watching the process now for going on 40 years. Over that time, some things have changed; and some things haven’t; and AEHC has been in the midst of it for almost all our 70 years.

In my last post I recalled how endorsement had gone from the individual bishop to AEHC, then the Office of the Bishop of Federal Chaplaincies. After that it went to the office of Mission. With that history in mind, let me clarify how the process works now. (And attached I have provided a flowchart.)

Once upon a time, it was individual bishops who endorsed for healthcare ministry. Now, it continues to be individual bishops who endorse for healthcare ministry. Yes, there is a process, but if an Episcopalian feels called specifically to healthcare ministry the first step is to be sure to have met with the bishop. This is true whether or not the prospective chaplain feels called to ordination or is pursuing certification. Healthcare chaplaincy is recognized as a specialized ministry and the Episcopal Church can endorse persons in any of the four orders for ministry. So, first be sure to connect to the bishop.

As referenced, for many of us the interest in ecclesiastical endorsement began in the pursuit of board certification. It is still required for the largest chaplain organizations (and I would encourage it for whether seeking certification or not). If you are pursuing certification, the next step is completing the form on line here. At this time this will be received by the Rev. Margaret Rose, Ecumenical and Interreligious Deputy to the Presiding Bishop, and our Endorsing Officer; and processed by Ann Hercules, Associate for Ministry Beyond the Episcopal Church. Note that the persons have changed at times, but the process has actually been stable for some time.

Note, too, when you look at the form, there is a requirement to affirm that you are up to date with the Church’s education on preventing and recognizing sexual abuse and ministry misconduct. This is normative for many ministries in the Episcopal Church, ordained and lay, paid and volunteer. Your diocesan office can help you get what you need.

Once the form is received, the Endorsing Office will reach out to the relevant bishop, asking if the bishop can endorse this applicant specifically for healthcare ministry (remember what I said to do first?). She or he will send the endorsement to the Office. Once received Margaret will send letters of endorsement to the endorsed chaplain and to the certifying body, with a copy to the bishop and a copy for the records.

Some have looked at the application and noted that it asks about certifying bodies. There has been concern that a person can only be endorsed if pursuing certification. Others have wondered whether chaplains not seeking certification are required to pursue endorsement. In fact, while many chaplaincy positions require certification, that’s not universal. However, I strongly believe every Episcopalian providing professional healthcare ministry should seek endorsement. For the reasons I have written before, I believe endorsement serves the Church, serves the chaplain, and serves the persons to whom the chaplain ministers. A person not seeking certification can be endorsed. Endorsement in that case, though, need not involve the form or the Endorsing Office. The chaplain can simply request and receive that directly from the bishop.

There is one further consideration. As noted the Episcopal Church will endorse persons in all four orders of ministry. However, if a lay person is endorsed, it is required that the endorsed chaplain arrange for a public service of commissioning. This both publically acknowledges the chaplain’s specialized ministry, and also the chaplain’s recognition of the authority of the Episcopal Church for that person’s ministry. Certifying bodies used to require this of all endorsed and certified lay chaplains. Because of the breadth of faith communities now involved in chaplaincy, the certifying bodies no longer require it. However, the Episcopal Church expects it, whether the endorsement is processed through the Endorsing Office or directly with the bishop.

Now, once endorsed, do you ever need to do it again? Really, that depends. Are you in a certifying body that requires periodic peer review or a similar significant review of the ministry? For example, APC requires that every five years. The Endorsing Office would like you to renew your endorsement at that point, including the Church’s abuse prevention training. 

It would also be appropriate to renew endorsement if a job change takes you to a new diocese. You would in any case want to meet with the new bishop, and would likely need to meet the expectations of that diocese for abuse prevention training. It would be appropriate at that point to renew endorsement. The process would be the same: either to resubmit the application through the Endorsing Office or to work directly with the bishop.

So, that is the process. Again, check the flowchart below. I have tried in it to concisely describe the steps of the process. Margaret Rose has also reviewed it, and approved it. We hope, then, that this description and the attached flowchart make the endorsement process clear. And, always feel free to reach out to AEHC colleagues for help.

Some Important History of Episcopal Endorsement

As I work on my post about how endorsement happens these days in the Episcopal Church, I rediscovered this paper. This was written in 2009, after the General Convention in Anaheim. Written in preparation for Bishop George Packard's retirement as Bishop of Federal Chaplaincies, it described how we came to work with Bishop Packard and his predecessors in the endorsement process. I thought it could be helpful to have some sense where we've  been when we talk about where we are now. Note that this post is also available at Chaplair, the blog of the Assembly of Episcopal Healthcare Chaplains.

A Concise History: The Relationship of AEHC and the Office of the Bishop of Federal Chaplaincies
 
The roots of this relationship are in issues of endorsement for certification in our various professional organizations.  In our polity in the Episcopal Church, endorsement came from our diocesan bishops.  A bishop might delegate that to a canon or archdeacon.  He (and at this point by and large it was always “he”) might choose to apply the same standards for endorsement for health ministries that he applied to military chaplains, and so only endorsing priests.  He might have specific standards for endorsement, or none at all.  To paraphrase Scripture, “everyone did what was right in his own eyes.”
 
This was a difficulty for the endorsing bodies, such as ACPE or the College of Chaplains (now incorporated into APC).  There was no standardization of what “endorsement” might mean in the Episcopal Church, nor how it was obtained.  They hoped for what they had in other endorsing faith communities: a single process overseen by a single office with authority from the community’s official structures.
 
In the late 1980’s under the leadership of Linda Smith-Criddle, AEHC approached Presiding Bishop Edmund Browning  and asked for assistance in this difficulty.  Linda was able to speak to a meeting of the House of Bishops and raise the problem.  Bishop Browning subsequently asked Bishop Hopkins, then his Assistant for Pastoral Care, to become our contact with the House of Bishops.  Linda also offered on behalf of AEHC that AEHC serve as the “office of record” for endorsements.  They would still be obtained from individual diocesan bishops, but AEHC developed a process and provided a contact point.  It offered a single process and a single point.  However, it still had no real authority from 815.
 
After several years, Bishop Hopkins asked to have the role as our advocate transferred. Bishop Browning asked the Bishop of the Armed Forces, Bishop Charlie Keyser to take this over.  Bishop Keyser was very willing and very hospitable to health care chaplains and health care issues.   At that point (I believe Razz Waff was President of AEHC), AEHC also asked Bishop Keyser to make his office the office of record for endorsements.  The decision was logical: the office was already familiar with administering the process of endorsement for military chaplains, and in most religious endorsing bodies it was already the case that both endorsements were coming from the same office.  Indeed, the list of military endorsement officers was the list that the College and ACPE were using to verify endorsing officers for health care.  It was also the case that, when a bishop was having difficulty or being difficult about health care endorsement, a call from another bishop was often more effective than a call from AEHC’s endorsing officer. Finally, in those days there was a good deal of concern about clergy misconduct and clergy liability. AEHC’s officers were concerned that as the endorsing agency, AEHC would incur liability if an endorsed chaplain were to be guilty of misconduct – liability that the national Church would be able to bear better than a membership organization within it.
 
So, the relationship was established.  For military and federal chaplains, the Bishop of the Armed Forces (known now, after several changes, as the Bishop of Federal Chaplaincies) had certain defined canonical responsibilities, and the chaplains had clear accountability. For others, including health care, corrections, and first-responder chaplains, the Bishop was an advocate and support, and the endorsing officer (although that title was usually with an Assistant for Health Care), while canonical accountabilities and responsibilties were between the chaplain and his or her diocesan bishop (and thus a reference to us as “diocesan chaplains” as opposed to “federal chaplains”).
 
When Bishop Packard became Bishop of the Armed Forces, he was happy to have the opportunity to advocate for health care chaplains in the House of Bishops and to oversee our endorsement process.  At the same time, he hadn’t been long in his position when the United States was attacked in 9/11.  Bishop Griswold gave Bishop Packard responsibility for disaster preparedness, in addition to his other duties.  With the help of our own Mike Stewart, who worked in the Office for a while, he helped dioceses make their preparations.  In addition, the responsibilities for military chaplains grew as the nation entered into war.  First there was Afghanistan, and then Iraq.  Then hurricanes Katrina, Rita, and Wilma added to his responsibilities in disaster response.  Since these were for him canonical responsibilities and responsibilities directed to Bishop Packard by the Presiding Bishop, he gave them the time necessary.  He could do so, even if it meant less time for health care issues, because we as chaplains were really responsible to our diocesan bishops.  He was bishop for military and federal chaplains, with disaster responsibilities added.  Our bishops were our respective diocesan bishops.  He did continue to maintain the endorsement process, but was not available for much else, however willing he might be.
 
Now Bishop Packard is preparing to retire, even as Presiding Bishop Katherine Jefferts Schori is reorganizing the offices of the national Church.  One of those changes has been to distribute offices and leadership out of New York, including an expanded office in Washington.  In that light, it makes sense for the Office of the Bishop of Federal Chaplaincies to move to Washington, closer to the center of those ministries.   She also decided that health care issues would remain with the Mission Center in New York, with a new person in staff support.  The person most likely to have those responsibilities when decisions are finalized after General Convention, is the Rev. Margaret Rose.  Some AEHC officers met her last fall.  The Rev. Bill Scrivener, President of ACPE and member of AEHC, and I had the opportunity to sit with her here in Anaheim for more than an hour.  I feel comfortable that she sees the importance in maintaining the endorsement process with as little change as is necessary.  It helps that Terry Foster, who handles that paperwork, is not moving to Washington.  We will still have a single endorsement process, overseen by a single office; and if a phone call to a bishop is necessary it will come from a member of the Presiding Bishop’s staff, if not from another bishop.
 
It has been good working with Bishop Packard.  While he has only been “our” bishop in a very limited sense, he has given us as much time and support as he could in light of his other responsibilities; and has always shown us clear enthusiasm and encouragement.  We will miss him, even as we trust we will still have clear and strong support from officers at 815.

So, since this was written some things have changed, but the process largely has not. That said, there are some comments to be made, and they will be in the next post.

A Classic on Ecclesiastical Endorsement

As I prepare to write about the current process for ecclesiastical endorsement in the Episcopal Church, I thought I would reflect on the value of endorsement itself. That's all the more important because things have changed in professional chaplaincy in the last few years. As a place to start, I looked back at the article below. It was written by Rod Pierce and myself and published in Chaplair in November 1999. When I write about the process I'll make some additional comments about the current situation; but while I work on that, please enjoy this reflection from twenty years ago.

Who Is an Episcopal Chaplain?

I have posted this both here and on Chaplair, the blog of the Assembly of Episcopal Healthcare Chaplains. I would hope that comments would be posted there, or both there and here, to encourage conversation among members of AEHC and friends of Episcopal Chaplains.

Twelve years ago I posted on my own blog , “To Become an Episcopal Chaplain.” All these years later, it is the most viewed of any of my more than 800 posts. I will be revising that post, as I have done in the past. However, as I prepare to bring that up to date, I wonder if it’s not worth asking a slightly different question: who is an Episcopal chaplain?

I want to think about this for several reasons. One is that the healthcare industry has changed a great deal over my career.  When I was President of AEHC I received several calls with the same question (including one from an office in the Episcopal Church Center): how many Episcopal hospitals are there? But, the question at the time was based on the assumption that most care, or at least most chaplains, was associated with hospitals. One thing I can confidently assert, though: there are fewer hospitals than at the beginning of my career. At the same time, there are more places chaplains are working. For some time, the fastest growing arena of healthcare has been hospice, the one corner of the healthcare industry that requires some form of chaplaincy. While I don’t have specific statistics, I also have a sense that there are more retirement communities and long term care facilities; and any associated with the Episcopal Church will have some provision for spiritual care.

That leads me then, too, to think about the future of AEHC. AEHC in one sense also started with that assumption. Indeed, our original title was the Assembly of Episcopal Hospitals and Chaplains. (We did recognize that the number of hospitals was shrinking. That’s why we changed the name.) If we are to serve the Episcopal Church, and to serve chaplains in the Episcopal Church, we need to consider how we will reach out colleagues in many different venues. 

That also means thinking about how we communicate and reach beyond our certifying bodies. I first became part of the College of Chaplains, one predecessor of APC, more than 30 years ago, and I believe strongly in the value of certification. The annual meetings of our certifying bodies have also made it easy for Episcopalians to gather. That challenges us with two opportunities. The first is to reach out to those who are not certified, and whose positions aren’t going to press them for certification. The second is to demonstrate the value of certification and to support and mentor those Episcopalians who pursue it. 

So, who is an Episcopal healthcare chaplain? The answer is certainly not a matter of order of ministry. Happily, the Episcopal Church can endorse a person in any order of ministry – any of the four – who demonstrates a call to ministry in healthcare.  Nor, really, is it a matter of venue. If the venue is focused on healthcare, a chaplain there is a healthcare chaplain.

That does, though, press us to think about how much healthcare focus we would want to require. There is no question that the care of souls in a parish or a school or a university setting does involve caring for folks with health issues. However, chaplaincy is a matter of focus. Pastoral care of the sick engages the sick person and immediate community. The Chaplain does so, and also engages the institution and in some meaningful sense integrates with the staff and administration.  So, I would insist that the chaplain is serving all patients or clients, and not only Episcopalians. That may not mean that the chaplaincy is paid, or is central to the income of the chaplain. I’m aware of more than one Episcopal long term care facility served by a parish Associate. That Associate participates in leadership, provides an on call response, and serves all residents. The associate is paid through the parish, but functions as a professional chaplain in care of that long term care facility. Another venue to consider is pastoral counseling, Any parish cleric will provide some pastoral counseling; but the professional pastoral counselor is focused on the wider community, and not an individual congregation. These are examples to help us distinguish the healthcare chaplain from the school chaplain, the correctional chaplain, or the military chaplain. (I would note, for example, that the Association of Professional Chaplains will consider unpaid work toward required hours for certification, but the functions must be those of a chaplain.)

Is an Episcopal chaplain endorsed for healthcare ministry? I am a strong advocate of endorsement, and will be writing more about the current status of endorsement. However, there is a lack of information about endorsement, especially among the bishops. That’s a problem, because we’re an Episcopal church, and endorsements are provided by bishops. We have an Endorsing Officer, and an Office of Record to communicate endorsement to the certifying bodies; but the endorsement itself (or the critical confirmation of it) comes from the diocesan bishop. Bishops can also endorse persons for healthcare ministry who are not interested in being certified. While I would very much want to see all chaplains endorsed, I don’t think our recognition of them should wait.

Should we have educational expectations of an Episcopal chaplain? This is an interesting question, with some interesting ramifications. Our current endorsement process only requires that the individual meet the diocesan bishop, and that the bishop feel the person has a vocation for healthcare ministry. I have often observed that in at least this we are virtually pentecostal. Other communions are more rigorous, to the point that one must have completed all paperwork toward certification before requesting endorsement. To some extent, we are better preparing professionals for healthcare work. All our seminaries integrate clinical pastoral education (CPR) into their programs; and many dioceses require or encourage CPE for ordinands who are alternatively educated. On the other hand, these may not be requirements for jobs. While Medicare will not reimburse for hospice care without a chaplain on the team, Medicare takes no position about the qualifications of the chaplain. Also, not only do we endorse lay persons without specifying an educational track, but many dioceses have most if not all ordinands in alternative programs for education that will not integrate CPE. This, like endorsement, can only be addressed with our bishops; and I don’t want to require AEHC to wait to engage such chaplains.

And, for all my enthusiasm to engage those working in healthcare chaplaincy, regardless of how they got there, I want to see us strongly encourage education and endorsement. In one sense, if one is to call oneself an Episcopal chaplain, one must also recognize that those outside the Church will expect a reflection of the Church. Sooner or later, the question is will arise, “What does the Episcopal Church say about…?” An Episcopal chaplain must at least be competent in not only the words but also the faith of the Book of Common Prayer. An Episcopal chaplain must have some sense of what the General Convention has said regarding engagement in the larger community. This is what education can form, and endorsement can confirm. I don’t think that requires a seminary education; but perhaps the same canonical expectations should apply. I don’t know that it requires CPE, but I don’t know of many comparable programs to help a minister understand himself or herself in the practice of spiritual care.

So, these are my first thoughts on the question, “Who is an Episcopal Chaplain.” I would hope we can have an interesting and a helpful conversation on this. I think it would be something to offer to the Church, and something to help shape the continuing mission of AEHC.

On the Tradition of Healthcare: Happy Holiday

Invocation for the Saint Luke's Health System Leadership Meeting, 11/30/2017. Our System is faith-based, rooted in the Episcopal Church. In radical hospitality, we are explicitly supportive of the traditions of all our patients, families, and staff.

 

Welcome to the Holiday Season! But, what is a holiday?

Our word "holiday" comes from older versions of English that spoke of "holy days." Not that the idea is particularly English: here are those days in any spiritual tradition that stand out, and that call for different behavior. Work stops. Sometimes even war stops. Families gather, communities gather, and do something different for the day. It may be to feast, or it may be to fast. It may call for quiet and private reflection, or it may call for public celebration and public service. It is a day that stands out, when believers stand out, from other days.

Welcome to the Holiday Season. Looking at November, December, and into January, and looking just at on line resources, there are special observations in ten different faith traditions, and several civic observations as well – and that’s without counting separately the distinctive practices within broader traditions. Some commemorate births. Some remember special revelations. Some are as much about cultural heritage as about religion per se, although those observing would not likely make that distinction. Certainly, this period is a season of holidays – of holy days – for many different communities.

 

There are those holy days that we might identify in this tradition of health care. There are those "first times." I remember the first patient seen in the Emergency Room at Saint Luke’s South, not long after midnight when we first lit the sign. We remember the first heart transplant, both that initial surgery half a world away, and the first one done at Saint Luke’s. We remember new resources and facilities, from the first hospital established 130 years ago to the completion of the new Anderson County Hospital. We remember special honors – state Quality awards, or the Baldrige: days of honor and prestige.

 

And then there are those more personal days. Every surgery is a holy day, a special day of observation for patient and family. Every discharge is a holy day, whether it is a day of feasting or fasting. Every birth is holy day, as is every death. It is our vocation, and also our privilege to participate in these holy days, directly or indirectly, and to work to make them days of honor and celebration; to make them memorable for hope and grace and compassion and mercy.

 

Welcome to the Holiday Season. May each of us in our own communities celebrate, knowing that our colleagues support us in celebration. And, may each of us in our health system celebrate those other "holy days," in support of those we serve, and those we serve with. Amen.

On the Tradition of Healthcare 6.29.2017

Invocation for the Saint Luke's Health System Leadership Meeting, 6/29/2017. Our System is faith-based, rooted in the Episcopal Church. In radical hospitality, we are explicitly supportive of the traditions of all our patients, families, and staff.

We as a group come from a number of different traditions. But, some of you have heard me suggest that there is a tradition we share, one that is a tradition of healthcare; and a recognition that healthcare in all its variations is holy work.

That tradition is old, older than we know. The Code of Hammurabi sets compensations and punishments for doctors and surgeons. Hippocrates learned his profession from his father and grandfather. Shimon ben Sirach was quoting his father when he wrote, 

Honor physicians for their services, for the Lord created them; for their gift of healing comes from the Most High, and they are rewarded by the king.

There is a tradition that is healthcare, healthcare as holy work, and we are all participating in it.

We, though, are not simply participating. We are leading. On the back of each badge in the room is our commitment to “the spiritual health of the communities we serve.” For us the communities we serve first, I think, are those we serve with. They are the physicians, yes; and also the nurses, therapists, technicians, engineers, housekeepers, volunteers - all those who share with us in creating and sustaining institutions of curing and healing, of caring and compassion and hope.

As we lead, there are various ways we might support the spiritual health of those we serve with; but I am sure this will be among them. We must reflect to them how each person contributes to the health and safety of every patient; and how each role expresses our commitments to service and compassion. We must recognize in them, and let them recognize in us, that we all participate in the tradition that is healthcare, and the knowledge that any service of healthcare - every service of healthcare - is holy work. Amen.

Interested in the Assembly of Episcopal Healthcare Chaplains (AEHC)? Benefits of Membership

Specifically for folks interested in the Assembly of Episcopal Healthcare Chaplains: several years ago I developed a list of benefits of membership. Two things occured to me. One was that I had never published that here. The other was that those thoughts needed to be reviewed. So, here for review (with some annotation) are the benefits of membership in AEHC.

-  Activities at the Annual meeting (commonly scheduled in conjunction with the Annual Meeting of the Association of Professional Chaplains [APC]):  the Episcopal Eucharist, participation in the Episcopal Breakfast, and the AEHC business meeting

-  The Episcopal Banquet at APC.  Ours is the function to attend, contributing to fellowship and networking with colleagues from across the country.  The President, President-elect, and Executive Director of APC are also invited to attend each year. Recently we have tried several different alternatives to a banquet to allow us to gather.

-  The AEHC web site (http://www.episcopalchaplain.org/; link in the right sidebar).  We share information with the membership, including membership information and web links.  We have recently completed an upgrade to the site.

-  The AEHC Facebook Page. AEHC maintains an open page in Facebook to share information and to raise the visibility of our work. It's another opportunity for members and supporters to hear about events and stories of interest.

-  Our listserv.  For those members who choose to join, it provides an opportunity for rapid communication and feedback from the Executive Committee, and from other Episcopalians in healthcare ministries. (We use the Mailchimp service, so you may need to review your Junk settings to allow our emails through.

-  Our Relationship with the Endorsing Officer for Healthcare Ministries, currently the Rev. Margaret Rose, Deputy for Ecumenical and Interfaith Collaboration, with the Office of Mission and Program of the Episcopal Church Center. Her Administrative Assistant, Terry Foster, has long processed our applications for endorsement. We benefit from their faithful ministries.

-  Our relationship with the Office of the Bishop Suffragan for Federal Chaplaincies, currently the newly elected Rt. Rev. Carl Wright.  The Bishop of Federal Chaplaincies has been another voice to advocate for healthcare ministries in the offices of the Episcopal Church and the House of Bishops.  The AEHC Executive Committee works to maintain clear communication and collaboration with the Bishop’s office.

-  Presence and visibility of healthcare chaplains at General Conventions of the Episcopal Church.  AEHC members have served as Deputies, as representatives of AEHC in the General Convention Exhibit Hall, and have assisted with the Office of the Bishop of Chaplaincies.  We’ve been present for most Conventions since 1994, raising the image of our work.  In Denver in 2000 that put us in a position to respond to resolution 2000-A079a, “Create an Association of Episcopal Health Care Groups and Individuals,” on advocacy in healthcare.  AEHC was noted by name in that resolution.  Two results of that resolution were the Formative Symposium for Healthcare (2001), and the conference “Waging Reconciliation: an Episcopal Response to Barriers to Health Care.” (2003). In Salt Lake City in 2015 current and former members of AEHC were able to touch base on the sidelines of Convention. 

-  Participation and representation in events of the Episcopal Church such as the Formative Symposium for Healthcare, “Waging Reconciliation: an Episcopal Response to Barriers to Health Care,” and the 2008 and 2012 meetings of the Standing Commission on Health.  AEHC officers have represented the organization in these meetings, allowing us to participate in shaping the church's positions on healthcare.

And now, to comment on some past benefits:

-  Chaplair, the AEHC newsletter, is published three to four times a year. (For the time being, Chaplair has been on hold. We continue to explore how best to communicate with our members and folks of interest, and at the moment Chaplair is part of that discussion, but hasn't been published recently.)

-  Representation at the JCAHO Forum of Liaison Organizations.  AEHC is a member organization of the Joint Commission’s Liaison Organization network. That gives us a voice when JCAHO is discussing new initiatives and regulations.  (While AEHC has been a member, The Joint COmmission has suspended its Forum of Liaison Organizations. Should they resume those gatherings, we will certainly be interested.)

AEHC has, I think, much to offer members, adapting as things change in chaplaincy and in the Episcopal Church. I hope you'll join me in membership.

Insight into Supporting Those Who Have Served in, and All Too Close To, Combat

I am just young enough that I did not have to worry about being drafted in the Viet Nam era. This not to say that I did not worry: I had already thought through how I might try to have some choice in my service if I was drafted (I had rejected the thought of somehow not serving). I registered as I was supposed to, but it didn't turn out to be an issue. As many will remember, in those waning days of Viet Nam the draft was determined by lottery; and just before my 18th birthday the lottery was suspended. That was not a call I received.

That was not to say, however, that I wasn't touched. I have older cousins, most of them women; and among their husbands were several who served. One of them was a career officer, who had more than one combat deployment. In our family that was appreciated and welcomed, if not always understood; but I was also aware of just how hostile the world outside the family could be for those returning veterans.

This comes to mind today as I have been reading the article "Only God Can Judge Me": Faith, Trauma, and Combat. The author is Nathan Solomon, a U. S. Navy Chaplain. I recommend it highly.

Central to Solomon's thesis are the categories of the Sent, the Senders, and the Liminal Ones. It should register immediately that the Sent are the service members who experience combat, whether directly or in support services. The Senders are, really, all of us: the nation, the society whose goals the service members seek to serve. The Liminal Ones are the chaplains who support the Sent. They are themselves Sent, and at the same time they bring something of the rest of us, the Senders, as well. 

For each of these groups, Solomon examines the experience in three categories: "What It Means," "What It Costs," and "Living With It." The explorations are honest, and through the paper the differences among the experiences of Sent, Senders, and Liminal Ones are well laid out. There is particular attention to how the churches (sic), both denominations and congregations, might want to examine ministries. 

While the article is written primarily for congregational clergy, I think there is value here for healthcare chaplains as well. Around us are those who have experienced combat trauma, among our patients and their families, and among our professional colleagues. While few of us could claim the same experiences, we do have some experience of serving with violent trauma, and that might make us - and call us to be - better listeners, better pastors, for those around us. 

And Yet Another Chaplain's Voice - This Time, A Familiar One

Faithful readers know that one of my simple pleasures is to share here when I discover a chaplain blogging. I have one to share, and I'm a bit embarrassed. This person is a dear friend and valued colleague. While her topics aren't only chaplaincy, she is a chaplain, and it shows up in her work. The chaplain is Joy Freeman, and her blog is Chaplainhood. Take the time to see what she has to share.

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.

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.

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.

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.

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.

Episcopal Ecclesiastical Endorsement 2015

I am writing this about Ecclesiastical Endorsement, and some refinements in the Episcopal Church's process. I do get to those in this post, but I encourage you to read the whole post so that those changes make sense. I could, I suppose, put the changes first and the explanation after; but, as Scripture says, “what I have written I have written.” Those who know me well won't be surprised.

As many of you know, I do my best to keep track of and post information about and changes in the process of becoming an Episcopal Chaplains. Indeed, my post To Become an Episcopal Chaplain, now all of eight years old, is still the most read post on the site. (Actually, if you’ve found this post because you’re interested in becoming an Episcopal Chaplain, you might want to read it first.)

One of the ways that I learn about changes is my own process. As a Board Certified Chaplain (BCC) with the Association of Professional Chaplains (APC), I am required to undergo a peer review process every five years. It’s part of maintaining my certification. I know that other professional organizations for healthcare ministries have similar requirements. As a part of that process, I apply to renew my Ecclesiastical Endorsement. Ecclesiastical Endorsement is required by APC and by other professional organizations; and while periodic renewal isn’t, it is a best practice that the Office of Mission at the Episcopal Church Center, which is where we connect for endorsement, has come to strongly encourage. (I have also written specifically about Ecclesiastical Endorsement. You can read those posts here. Be sure to sort by date to see the posts in order.)

Renewal of certification is not the only time when one might want to renew Endorsement. If an Episcopalian with Endorsement changes positions and moves from one diocese to another, we would recommend renewing endorsement even if not changing canonical residence. This would be true whether the chaplain is ordained or lay.

Let me give some explanation of that and remind us all of how endorsement works in the Episcopal Church.  I usually say that endorsement is a joint action of the Episcopal Church Center and the diocesan bishop. That’s true of the process. You complete the application and it goes to the Office of Mission. When that is received electronically, either the Rev. Margaret Rose or Terry Foster will reach out to the diocesan bishop for confirmation that the individual applying is known (both person and ministry) and has a vocation for healthcare ministry. When confirmation is received, the Rev. Margaret Rose will send a letter to the individual and to the professional organization confirming Ecclesiastical Endorsement in the Episcopal Church. (There may be some interested in Endorsement who are not seeking to gain or maintain certification. More about that below.)

If you think that through, the most important contact that happens in that process isn’t the application or the phone call from New York to a bishop. The most important contact is the meeting and conversation with the diocesan bishop (or bishops, if you live in one diocese and work in another) so that the chaplain and ministry and vocation are known to said bishop(s). We are, after all, an episcopal church; and so nothing of this nature will happen without a bishop’s consent.

That’s more than just a procedural concern. In my earlier post, I quoted from “A Covenant Between Religious Endorsing Bodies And Pastoral Care Certifying Bodies.” That covenant also includes this:

Endorsement is an exclusive covenant relationship between the faith community/tradition and endorsee. The faith community pledges to provide support and discernment to those seeking to enter pastoral care ministry and guidance, support and oversight to those who serve in these ministries. The endorsee agrees to ongoing participation in the life of his/her faith community as well as maintaining communication and accountability to the endorsing agent.
Endorsement addresses the following core standards through a process of written papers, interviews and mutual discernment:

• Ministerial and theological competence• Good standing and accountability within that faith community• Ability to work collegially in diverse and pluralistic environments• Willingness to adhere to the codes of ethics prescribed by the faith groups, institutions served and the agencies providing certification• Continuing spiritual formation and review• Academic and clinical educationEndorsement is not a legalistic ritual; rather it is a mutual covenant and relationship between the endorsee, the endorsing faith group and the certifying body. Each and all are to benefit.

Accountability is important for the chaplain serving, for the person served, for the employing institution, and for the faith community providing endorsement. The certifying bodies aren’t in a position to determine whether someone has “good standing and accountability within [a] faith community,” or “continuing spiritual formation and review.” For us as Episcopalians, our accountability within our faith community is expressed in accountability to a bishop, and without the awareness and acceptance of the appropriate bishop(s), endorsement will not happen.

In that instance, the Office of Mission serves as a single contact for most of us involved. It’s where the certifying bodies look for confirmation of endorsement. It is where bishops connect to give imprimatur. It is where we send our applications. However, in that process, while we might talk of the Office of Mission as the Endorsing Office, it is more accurately an “office of record,” where our application and the bishop’s response is recorded for the benefit of all three parties.

So, does every Episcopalian engaged in healthcare ministry need to request Endorsement? At this date, the application is focused on those who are seeking certification. Are there other circumstances? Yes, there are. There are employers who are not committed to certification but who request Endorsement to demonstrate accountability. There are colleagues who are engaged in institutional healthcare ministries on a regular basis because there's an institution associated with the parish; or because a local institution knows the minister and feels the minister suits the needs of those served. For those persons, it would still be important to be in contact with the bishop. Because ultimately it is the word of the bishop that endorses, those individuals can request the bishop to endorse individually. Moses said, "Would that all God's people were prophets;" and I have sake, "would that all God's bishops required endorsement in some form of all the healthcare ministers in their dioceses." Once again, what makes for functional accountability and functional endorsement is the knowledge of the bishop about the healthcare minister and her or his ministry.

So, central to the process of Ecclesiastical Endorsement in the Episcopal Church is the connection between applicant and bishop, which begins directly and is may be recorded by the Office of Mission. To better reflect that connection and accountability, there have been changes to the application form for endorsement. Specifically, there are three questions you might not have seen if it’s been a while since you renewed endorsement.

The first is a request to give the specific date when the applicant informed the bishop of the intent to apply for endorsement. If you are in reasonably regular contact with your bishop, that may take no more than an email. If you’re applying for the first time, or you’ve recently changed dioceses, a meeting is in order.

The third question (yes, I’m coming back to the second) is for those who are canonically resident in one diocese but working in another. It asks who that second bishop is. It’s a clear reminder that it would be important to be in contact with that bishop.

The second question is the one that will take a little more effort. The applicant is asked when he or she completed the sexual misconduct training required in the Episcopal Church and provided in every diocese. The Office of Mission is now asking that the training (or renewal of training) has happened within the last five years. Indeed, you can’t choose a date more than five years ago. 

That was one that applied to me. I’ve been trained and retrained several times, what with job and diocese changes and all. However, I’ve been in the same diocese and the same system for 21 years now. My last renewal was about eight years ago. Now, there are behaviors for which I am accountable to my health system, and to which I recommit each year with my annual goals (and the behaviors our misconduct prevention training teach are covered, generally if not specifically). I certainly have the date when last I renewed my accountability to my employer. However, I thought it worthwhile to contact the diocesan office and learn what renewal education might be available. That protects me, the Office of Mission, and the bishop from questions later about my accountability. A renewal module was available on line from the Church Pension Group. It took me about an hour to complete. Now I have a record that I’m up to date, and so does my diocese. It was a change I hadn’t originally expected, but well worth the small amount of time required.

Note that I had originally been trained and retrained because of my ordination. However, any of us active in ministry in a parish (lay or ordained) probably know by now the expectations of the Episcopal Church (through the Episcopal Insurance Corporation, and so the Church Pension Group) that all in significant ministries have the sexual misconduct training. It is just a basic component of how we make our churches safe places for all, and especially for children and youth. If you’re endorsed and you haven’t run across this, I’m very surprised. If lay and applying for the first time, when you meet with the bishop be prepared to talk about this. It is an important measure in our accountability as ministers who function in healthcare, and who reflect the ministries of the Episcopal Church.

So, that’s what’s newest about Ecclesiastical Endorsement in the Episcopal Church. Read, mark, learn and inwardly digest. Get endorsed. Get endorsement renewed. These are simply opportunities for us to claim both our ministries and our accountability as chaplains serving as ministers of the Episcopal Church.