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Gaps in Chaplaincy Profession Still Ring True

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The Rev. Dr. Walter J. Smith, S.J., was my predecessor as president and CEO of HealthCare Chaplaincy, serving in that role from 1991 to 2013. In 2012, in recognition of his contributions to the field, the COMISS Network (The Network on Ministry in Specialized Settings) honored Walter with its highest recognition - the COMISS Medal. On that occasion, Walter declared a call to action for professional chaplaincy (see his complete address below).  To highlight two excerpts: 
  • "The current system in professional chaplaincy is not sustainable and we must develop and embrace a different mode ...Without an empirical base that validates the outcomes of their professional work, chaplaincy as a profession will remain on the margin of health care, and not be able to justify further investment of limited health care dollars to support its professional endeavors."
  •  "Despite many good efforts, chaplaincy still lacks an organized, strong, united, proactive and representative national voice.  Chaplaincy as a field is not a significant professional participant in the national health care policy debate, nor does it have an appropriate and sustained lobbying presence with those who are playing key roles in shaping the future of American health care.  Chaplains have to be at the table and speaking persuasively if their contributions are to be understood and included as the health care landscape is being re-engineered."
Walter had delivered this message in previous years. So had other thought leaders in the professional chaplaincy field. The problem as I see it is they still do today.  The same message.  The same concerns.  Why when there is so much that can be getting done?

Very recently, we've seen the emergence of evidence-based quality indicators and scope of practice - the work of two distinguished international panels of experts convened by HCCN. These evidence-based criteria are a vital start. (Details here.)
But not enough has been done to strengthen the health care chaplaincy profession.  Not enough has been done to support chaplains in their role.
Not enough has been done to advocate for the profession.
There is much more to accomplish. Now is the time to make spiritual care a priority.

I welcome your comments.  Please send to comm@healthcarechaplaincy.org.

Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network, Inc.

Alexandria, Virginia
8 January 2012
The Rev. Walter J. Smith, S.J., Ph.D.
President & CEO
HealthCare Chaplaincy
New York City
Last month in New York City, I participated in some unrelated events and meetings in an iconic building on Fifth Avenue, which is the landmarked home of the New York Academy of Medicine. 
During the early period of its venerable one hundred sixty-five year history, the Academy of Medicine was an enclave principally of male physicians and surgeons, who eventually-at the turn of the twentieth century-found their way to admit women to their fellowship, and even more recently, to recruit and elect colleagues from the other health professions. 
About fifteen years ago, I was elected a Fellow of this prestigious body, which currently is engaged in a number of cross-disciplinary leadership projects that seek to create environments in cities that support healthy aging; strengthen systems that prevent disease and promote public health; and eliminate health disparities.
Each of the meetings in which I participated in the Academy's building was focused on an intensely collaborative endeavor of civic engagement, health advocacy or health policy reform.  Even though the agendas and outcomes of each of these gatherings were different, they all underscored for me a critical common reality: every important initiative today-whether public or private-relies for its success on an ability to engage the knowledge, experience and effective collaboration of people from diverse professions and academic disciplines. 
These working meetings convened at the New York Academy of Medicine reinforced my belief in the necessity to foster and sustain effective collaborations and served as a catalyst for my thinking as I was formulating these reflections for the annual gathering of representatives of the Council on Ministry in Specialized Settings (COMISS). 
When COMISS was established in 1979, its founding vision was to become the preeminent network for professional organizations, institutions and faith communities.  It aspired to increasingly promote and support collaboration among its members and be a forceful advocate and collective voice for five distinct, but interrelated groups: 
(1) Professional chaplaincy and pastoral counseling certifying organizations;
(2) Professional chaplaincy and pastoral counseling accrediting organizations; 
(3) Religious judicatories that provide endorsement for chaplains and pastoral counselors to perform ministry in specialized settings; 
(4) Professional pastoral care and educational organizations, and lastly;
(5) Chaplain and pastoral care counselor employing organizations, like HealthCare Chaplaincy,  which I represent, that utilize the services of chaplains or pastoral counselors certified by one of the certifying member organizations of the COMISS Network.  
Now, at the dawn of 2012 - some thirty-three years later - we gather to consider the topic: "Professional and Practical: Engaging Pastoral and Spiritual Care Resources."  In offering these observations and personal reflections, I do not intend to be either contentious or confrontational, but to speak candidly and constructively-from the perspective of my own experience-about the serious problems, both professional and practical, that the fields of chaplaincy and pastoral counseling are facing.
For much of its modern history, chaplaincy and pastoral counseling have virtually been the domains of solo practitioners, who effectively have been "going it alone."  It wasn't until 1946 that chaplains began to associate themselves together professionally, and then, as you know, chaplains tended to organize themselves by faith traditions and service specialties. These organizational structures have had the secondary effect of reinforcing fragmentation and progressively weakening the collective voice of these helping professions.
Over the past sixty-six years, chaplains and pastoral counselors have continually struggled to be recognized, respected and compensated as bona fide health care professionals.  Chaplaincy and pastoral counseling membership associations, which were initially established to foster a sense of identity and accountability to peers, have grown into well-organized professional groups that are more collaborative than competitive.  Yet, despite the rhetoric, covenants and strategic planning that have dominated the professional landscape during the past quarter century, professional chaplaincy and pastoral counseling still have not achieved emancipation from the historical shackles that have obstructed their growth as spiritual care helping professions.
More obvious barriers that tend to divide groups- including issues of gender, ethnicity, race, sexual orientation and religious affiliation-are being confronted, and the pastoral and chaplaincy care professions are seeking better ways to collaborate and utilize their limited economic resources to support common strategic interests. 
But other obstacles to the realization of the expansive vision that gave birth to COMISS more than three decades ago remain significant deterrents.  I would like to reflect on some of the more neuralgic issues that impede progress and development within our professions.
I will focus the remainder of this discussion on the field of professional health care chaplaincy, although these observations may apply and be relevant to the other cognate spiritual and pastoral care professions and subspecialties as well.
Looking specifically at the health chaplaincy care profession in America, I find it personally disappointing that after more than a decade since our important conjoint meetings in Toronto in 2000, the major national chaplaincy associations in North America have not found an effective and sustainable way to operationally merge their related missions and purposes and pool their dwindling fiscal resources, governance and executive leadership. 
In an article published in a national news journal ["Collaborative Efforts Can Save Money And Improve Care," Kaiser Health News, Jan 5, 2012], a couple of quotes caught my eye.  The first was from a vice president of a national alliance of 200 health systems that are focused on performance improvement:  "It all starts when leaders in a community say the current system is not sustainable and we've got to find a different model."
The current system in professional chaplaincy is not sustainable and we must develop and embrace a different model.  Chaplaincy still has not been able to remove certain roadblocks to its collaboration and growth as a unified profession.  A second quotation in the Kaiser Health News article states the problem even more succinctly:  "There are still many obstacles to such partnerships.  It's often difficult to get traditional competitors and antagonists to collaborate, including sharing proprietary medical and financial data."   
While I would not like to say that Association of Professional Chaplains (APC) and the National Association of Catholic Chaplains (NACC) and the National Association of Jewish Chaplains (NAJC)  and the Association for Clinical Pastoral Education (ACPE) are traditional competitors or antagonists, but as of yet, they have not felt the crisis urgently enough to put aside self-interests and realize that a single, consolidated, stronger, national organization will serve their members and the profession far more effectively.
While some encouraging and commendable progress has been made during the past decade in important areas, including the development and ratification of standards for certification, ethics and professional practice, these national membership organizations still struggle to maintain their own independent identities and cultures, as well as to fund and staff costly and redundant infrastructures. 
Despite many good efforts, Chaplaincy still lacks an organized, strong, unified, proactive and representative national voice.   Chaplaincy as a field is not a significant professional participant in the national health care policy debate, nor does it have an appropriate and sustained lobbying presence with those who are playing key roles in shaping the future of American health care.  Chaplains have to be at the table and speaking persuasively if their contributions are to be understood and included as the health care landscape is being re-engineered.
The professional chaplaincy organizations are being forced to invest much of their shrinking financial and human resources in maintaining essential operating structures and programs, with limited additional and necessary funds to strategically invest in growing chaplaincy as a profession. 
Let me offer one brief example. Even though these organizations worked diligently to develop and ratify common certification standards that define the skills that a professional health care chaplain must possess, these certifying bodies have not sponsored any subsequent research to validate these standards against chaplaincy outcomes and performance measures.  Without a credible body of research to support it, standards like these will accomplish little in advancing chaplaincy as a profession.  Professional chaplaincy today still lacks the models and methods on which to build a strong empirical foundation that will help define what chaplains do and  measure how successful are their interventions. 
Professional health care chaplaincy's strengths over the past half century have been concentrated in two principal areas, one clinical, the other educational: (1) to provide care at the bedside; and, (2) to develop a content-informed, progressive experiential learning educational paradigm (i.e., Clinical Pastoral Education), which continues to serve as the foundational educational paradigm by which all aspiring professional chaplains are prepared for certification and practice.  
Turning attention briefly to the first of these strengths-clinical pastoral care-it fair to say that much of current chaplaincy care practice remains intuitive and insufficiently documented.  The chaplain, as a solo practitioner, enters patients' worlds with the desire to help individuals to make sense of and find meaning in what they are experiencing.   The chaplain comes to this task with a reasonably sufficient training and experience, but only exceptionally equipped with theories or methods to critically assess the effectiveness of what he or she actually says or does in the clinical setting. 
Generally speaking, many chaplains affirm anecdotally that their interventions do seem to help patients to create or modify their own existential and/or theological "models" and to better understand and accept what is happening to them as a result of an illness, disability or aging.   But, in general, chaplaincy practice issues are not routinely subjected to the rigors of scientific inquiry because most chaplains have been insufficiently trained or encouraged to research these kinds of questions themselves.
Remedying this deficiency does not seem to be on the national agenda of their membership organizations, for good and explainable reasons.  But without an empirical base that validates the outcomes of their professional work, chaplaincy as a profession will remain on the margin of health care, and not be able to justify further investment of limited health care dollars to support its professional endeavors.
This brings me, finally, to what I consider one of the most exigent challenges facing chaplaincy as a health care profession.   As noted earlier, the educational paradigm common to the professional formation of every board-certified chaplain is Clinical Pastoral Education.  While broadly encouraging personal growth and developing a useful set of helping skills  for future chaplains, the CPE curriculum does not prepare the same chaplain-in-training to assess the effectiveness of what he or she may do in the clinical setting or to plan and conduct studies and evaluate the data of qualitative and/or quantitative research.  
Few CPE supervisors (chaplaincy care educators) possess quantitative or qualitative research skills or have sufficient research experience to be able to teach these basic skills to others. Research needs to become a standard part of the CPE curriculum, and resources need to be invested to help CPE supervisors and board-certified chaplains acquire and/or strengthen their research skills.
A recent comprehensive literature review, funded by the John Templeton Foundation and completed by HealthCare Chaplaincy (HCC) under the Reverend George Handzo's leadership is currently available on HCC's website.
This exhaustive review has identified the substantial gaps that exist in understanding what chaplains do and the knowledge on which their practice is based, and how a chaplain's clinical judgment is formed and tested. This report underscores the need for basic research to explore the way in which chaplain practice protocols may be developed and maintained and to investigate the relationships among chaplaincy care protocols, clinical judgment and accountability.
These deficits in contemporary chaplaincy practice and education are intensified in a contemporary healthcare culture that requires all professional disciplines to document and assess of the outcomes of every intervention.  Chaplaincy care is no longer immune from this requirement, even though we believe that what we provide is high-quality care.  Without an ability to reliably document what we do and how we assess the outcomes, the professional work of chaplains will remain occult and underappreciated for its essential value to patients and their loved ones.  Without developing matrices and testing measures, chaplaincy as a health care profession will further weaken and continue to be marginalized.
From my vantage point of a half century as a Jesuit behavioral scientist engaged in clinical, academic and nonprofit managerial ministries, I would venture to assert that health care chaplaincy, as a professional discipline, may be as aligned to  medicine,  nursing and social work as it is to its many spiritual and religious roots.   And I further believe that by assisting chaplains and chaplain educators to better understand and embrace the functional relationships chaplaincy shares with the other cognate health professions will accelerate the development more integrated and effective approaches to multidisciplinary care. 
At HealthCare Chaplaincy, we are currently in engaged in shared efforts to help reform our national health care policies.  We also believe that professional chaplaincy care may play a pivotal role in promoting quality decision-making by patients and their loved ones than any other input source on the healthcare team.  If this assumption is validated, chaplaincy may come to be understood as an optimal discipline to help rationalize medical spending and improve patient satisfaction-two not inconsequential outcomes in managing the economics of health care today and tomorrow.
For these and other reasons, with a $3 million grant from the John Templeton Foundation, we are working together with chaplains and other experienced social and behavioral science researchers over the next two and a half years to expand research capacity within the field of professional chaplaincy.  
We hope that through these initiatives and partnerships we will stimulate development of a consensus model or models that will help test conceptual and practice-based assumptions about health care chaplaincy (with a particular focus on palliative care) and enable future researchers (chaplains and others) to build on and further advance what these seminal efforts can be expected to achieve. 
Our objective is to select the best or most interesting research projects from among those submitted for review and to support those investigators, particularly professional chaplains, who will best advance the nascent field of health care chaplaincy.
What distinguishes this grant-making cycle from others are two important assumptions:  (1) this is a field-defining and field-changing initiative; and (2) we are looking to enable and support the skills development of an emerging group of chaplain-researchers who will form the core of a sustainable generation of researchers to lead and advance the field of professional chaplaincy.
Let me conclude this reflection by returning to my beginning.   For far too long, chaplaincy historically has "gone it alone," and has suffered greatly from its fragmentation and isolation.   As a profession, health care chaplaincy remains under-resourced and insufficiently equipped to describe what it does and measure the effectiveness of its clinical practices. 
The profession possesses a rich anecdotal collective experience that supports the conviction that spirituality matters in the organization and delivery of healthcare.  Bolstered by a unified national leadership and a solid research foundation and growing body of meaningful data, professional chaplains and the membership organizations that support them, will be able to speak in more compelling ways.  Finally, if their representatives can find a way to consolidate their organizations and resources, professional chaplains will have a single, strong and articulate voice to speak for them.  They will be able to demonstrate the effectiveness of their contributions with evidence-based best practices.
In the end, as members of multidisciplinary care teams, professional chaplains will have earned their rightful place as champions and guarantors of fully integrative care.
HealthCare Chaplaincy Network, 65 Broadway, 12th Floor, New York, NY 10006-2503
Sent by news@healthcarechaplaincy.org in collaboration with
Constant Contact


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