Reforming Chaplaincy Training The Rev David Fleenor BCC ACPE Supervisor Director of Education Vansh Sharma MD Director of Research Deborah Marin MD Director of Center for Spirituality and Health ID: 770990
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Reforming Chaplaincy Training The Rev. David Fleenor, BCC , ACPE Supervisor, Director of Education Vansh Sharma, MD, Director of Research Deborah Marin, MD, Director of Center for Spirituality and Health
Center for Spirituality and Health Clinical Services Research Community Engagement Education
Evidence Based Care Clinical Judgment Pt. Values and Expectations Best Available Clinical Evidence Established Clinical Principles Improved Patient Outcomes ( Sackett , Rosenberg, Gray, Haynes, & Richardson, 1996; http:// tools.aan.com/practice/blog/post.cfm/evidence-based-not-evidence-only-the-three-pillars-of-ebm , Feb., 2012)
What is Evidence Based Spiritual Care? “…the use of scientific evidence on spirituality to inform the decisions and interventions in the spiritual care of persons.” George Fitchett, J. A. (2014). Evidence-Based Chaplaincy Care: Attitudes and practices in Diverse Healthcare Chaplain Samples. Journal of Health Care Chaplaincy, 20 (4), 144-160
How do we train chaplains to provide EBC?
Center for Spirituality and Health
What about CPE works?
What about CPE does not work?
Reforming Chaplaincy Training re·form rəˈfôrm / verb gerund or present participle: reforming make changes in something (typically a social, political, or economic institution or practice) in order to improve it.
What is Chaplaincy training? “Clinical Pastoral Education is interfaith professional education for ministry .” https ://www.acpe.edu/ACPE/_ Students/FAQ_S.aspx
History of CPE CPE began as a reformation movement within theological education From academic theology to clinical theology For ministers in congregations
History of CPE Professional health care chaplaincy was an unintended consequence of CPE CPE was designed to form better congregational ministers, not health care chaplains
History of CPE “…while the medical establishment increasingly focused on what became known as “evidence-based practice,” CPE clung to professional formation and educational methodology. The early stages of healthcare chaplaincy did not follow the route of medical education. Rather than affiliating with the institutions where they would practice, chaplains were more tied to religious organizations that were primarily concerned with congregational life. The result was that chaplains found themselves on an island between two of the three historic professions but embraced by neither.” Tartaglia, A. (2015). Reflections on the development and future of chaplaincy education. Reflective Practice: Formation and Supervision in Ministry , 35, 116-133.
History of CPE Chaplains
Who takes CPE?
Who takes CPE? Theological students Aspiring professional chaplains
The Dilemma Who are we training? Aspiring Religious Professionals? Aspiring Health Professionals?
The Dilemma How do we address this dilemma? Aspiring Religious Professionals? Aspiring Health Professionals?
The Dilemma Specializations CPE for Theological Students CPE for Health Professionals CPE for Aspiring Chaplains
Why reform Chaplaincy training? Because health care has changed! Health care is evidence-based Health care is oriented towards the evaluation of patient-centered outcomes “The educational goals and outcomes of CPE weren’t designed or intended to address the same needs and questions as that of evidence-based and patient-centered outcomes in healthcare .” - Massey Massey, K. (2014). Surfing through a sea change: The coming transformation of chaplaincy training. Reflective Practice: Formation and Supervision in Ministry, 34, 144–52.
Why reform Chaplaincy training? So tomorrow’s chaplains are evidence-based practitioners of spiritual care focused on patient-centered outcomes.
Reformers Kevin Massey, M.Div., BCC Vice President of Mission and Spiritual Care Advocate Lutheran General Hospital in Chicago, IL. Wendy Cadge, Ph.D. Professor of Sociology Brandeis University Lex Tartaglia , D.Min ., BCC, ACPE Supervisor Senior Associate Dean School of Allied Health Professions Virginia Commonwealth University
Calls for Reform
Example of Evidence Based Spiritual Care King, S. D., Fitchett , G., & Berry, D. L. (2013). Screening for religious/spiritual struggle in blood and marrow transplant patients. Support Care Cancer, 21(4), 993-1001.
Example of Evidence Based Spiritual Care Massey, K., Barnes, M. J., Villines , D., Goldstein, J. D., Pierson, A. L., Scherer, C., . . . Summerfelt, W. T. (2015). What do I do? Developing a taxonomy of chaplaincy activities and interventions for spiritual care in intensive care unit palliative care. BMC Palliat Care, 14, 10.
CPE at Mount Sinai At Mount Sinai we seek to form chaplains who are: Emotionally intelligent Culturally competent Theologically reflexive Ethically guidedResearch literateOutcomes oriented
Competencies ABMS Core Competencies Related Chaplaincy Competencies Practice-based Learning and Improvement Show an ability to investigate and evaluate patient care practices, appraise and assimilate scientific evidence, and improve the practice of medicine. Demonstrate knowledge of relevant developments in evidenced-based and best practices in chaplaincy care through reading and reflecting on the current research and professional practice. 1 Seek and create opportunities to enhance the quality of chaplaincy care practice by engaging in continuous quality improvement. 2 [ 1] APC Standards of Practice , Standard 12 [2] APC Standards of Practice , Standard 11
Competencies ABMS Core Competencies Related Chaplaincy Competencies Medical Knowledge Demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and their application in patient care. Demonstrate knowledge of relevant developments in evidenced-based and best practices in chaplaincy care through reading and reflecting on the current research and professional practice. 3 [3 ] APC Standards of Practice , Standard 12
Competencies ABMS Core Competencies Related Chaplaincy Competencies Interpersonal and Communication Skills Demonstrate skills that result in effective information exchange and teaming with patients, their families and professional associates (e.g. fostering a therapeutic relationship that is ethically sound, uses effective listening skills with non-verbal and verbal communication; working as both a team member and at times as a leader). Employ communication strategies that include active and attentive listening, awareness of non-verbal, appropriateness, and relevant content. 4 [4 ] CASC Competencies for Spiritual Care and Counseling , Competency 4
CPE at Mount Sinai We are bringing a medical model of education to chaplaincy training through: Research seminar Journal club Clinical preceptors
Research Seminars Scientific research-oriented events consisting of a small group of investigators and students working together with a view to addressing topics in depth and in searching to break new ground. Topics sample: Previous research on religion, spirituality and health Strengths and weaknesses of previous research Applying findings to clinical practice
Study Description Type of question asked (e.g., diagnostic, therapeutic, prognostic, etiologic, or economic) Type of method used (e.g., randomized controlled trial [RCT], retrospective cohort, case-control, meta-analysis, cross-sectional, descriptive, decision analytic, or cost effectiveness) Study site location, where relevant (e.g., multicenter, Veterans’ Affairs [VA], population-based, academic medical center, subspecialty clinic) Outstanding features (well-known author, first of its kind study)
The Research Question Has 4 basic components (PICO )Population: Who were the subjects?Intervention(s) (or exposure): What was the therapy, risk factor, test(s), survey? Comparison or control: What was the alternative group to the intervention or exposure?Outcome: Was it clinical , functional, economic ?
Journal Club A group of individuals (staff and students) meeting regularly to learn how to critically evaluate recent articles in the academic literature that is specific to the field of spirituality and religion
Relevance/Context of the Question C oncisely state the importance of the question This information can usually be found in the introduction, where the authors put their study in the context of other literature.
The Methods Give more details on the components (PICO) of the research question Population – Who & how many subjects were studied? Interventions – What was done? Control – Was there a comparison group?Outcome – What outcomes were looked at?
Critical Appraisal of Validity * “Bias” in the methods Bias in selecting subjects for the study – “Selection” bias Selection of outcome measure(s)Does the study measure what patients consider important (content validity)? Are the instruments used reliable (when measuring severity) or responsive (when measuring change)?Are there important aspects of the question that have not been measured?Do not get lost in the statistics/analysis section!“Statistics are a tool while study methods rule!” * Background reading beyond the paper may be required
Summarize the Results Limit summary of the results to the primary question and only present secondary results if they are relevant. Helpful to bring listeners’ eyes to a particular row on a table or a bar on a graph to illustrate a point.
Discussion of Strengths and Limitations Describe if the results apply to your patients Can you apply these results to your patients? Are the patients or setting so different from your own that the findings are useless to you ? How much would you have to adjust the study findings to compensate for the differences between the study’s patients or setting and your own?Conclude with your decision about the utility of the study in your practice, or contribution to the field (i.e. advancing knowledge)
Future Directions Closing the gap between evidence and practice: Mindfulness Based Stress Reduction (MBSR)
The Future of Chaplaincy Training? What do you imagine chaplaincy training will look like in the future? What other novel approaches to chaplaincy training should we consider?
Why reform Chaplaincy training? Because the religious landscape has changed!
Why reform Chaplaincy training? Because the religious landscape has changed! How important is it that professional health care chaplains belong to a religious tradition? Could you see a day when that is no longer a requirement?
Solutions? H ealth care chaplains need to provide evidence-based care. Health care chaplains need not be affiliated with a particular religion.
Questions?