A Case for Standardizing Education for Health Care Chaplains (HINT: More Research is Needed First)
Updated: Oct 7, 2021
The field of health care chaplaincy is young compared to other health care professions. What began in the 1920s as an attempt to reform Protestant theological education has developed into a bona fide profession today (Cadge et al., 2019). Two-thirds of the hospitals in the United States have hospital chaplains (Cadge, 2012). A 2019 survey of approximately 1,000 Americans found that 21% had had contact with a chaplain in the last two years; 57% of those reported it was in the context of health care (Cadge et al., 2020). What training enables one to become an effective health care chaplain? What knowledge, skills, and attitudes must one demonstrate to be considered proficient as a spiritual care specialist? These questions remain unanswered despite the fact that people have been in training for health care chaplaincy for over a century. Chaplaincy training today is based on an unbalanced and outdated model that prizes the development of the practitioner over the development of specific competencies needed to consistently function at a high level. Health care chaplaincy education should be standardized so health care organizations and patients may receive high-quality spiritual care no matter who their chaplain is.
The pathway to becoming a board-certified chaplain is long and multifaceted. It begins with earning an undergraduate degree followed by a graduate degree with a minimum of 72 credit hours. Many seminaries and schools of theology require their students to complete one unit of Clinical Pastoral Education (CPE), which, for many, is their first experience of chaplaincy. A CPE unit is a 400-hour program in which 250-300 hours is spent providing spiritual support to patients, families, and staff, and 100-150 hours are spent in a combination of individual and group clinical supervision. Applicants for board certification are required to have completed four units of CPE. One may complete four independent units or enter a CPE residency, which is a one-year full-time program that provides three to four CPE units. Upon completion of four units of CPE, one may begin counting time spent providing chaplaincy towards the 2,000 hours of work required for certification. Finally, aspirants for board certification must demonstrate in writing and in person their competence in 31 areas.
Massey (2014) astutely argued that reformations in health care - the emergence of evidence-based practice, the focus on patient-centeredness, and changes in payment models - have fundamentally changed the training needs of many health care professionals, including chaplains. Chaplaincy training has focused on developing the professional identity of the chaplain, not on teaching propositional knowledge or the discrete skills needed to effectively provide spiritual care (Massey, 2014). Massey (2014) advocated for the development of more curricula to match the needs of today’s health care chaplaincy students and for it to be standardized so that health care organizations and patients receive the same quality of care.
There are countless examples of how CPE curricula are misaligned with the training needs of today’s health care chaplains. Fitchett et al. (2015) found that the curriculum of most CPE residencies does not specifically focus on the competencies required for board certification. Another study of CPE residency curricula showed that only 19% of programs used a published model of spiritual care documentation in the electronic medical record, thus contributing to chaplains’ marginal role among other interprofessional health care professionals (Tartaglia et al., 2016). Tartaglia (2015) wisely advocated for exploring new training models specific to health care chaplains that begin with identifying the outcomes first, then the educational methods and structures.
For decades leaders in health care chaplaincy have debated about the need for a standardized curriculum but very few steps have been taken in that direction. Having lost their patience, some of these leaders set out on their own and developed a new chaplaincy certifying organization in 2016 called the Spiritual Care Association (SCA). The SCA offers a competency-based approach to certification that relies less on the amount of time someone has spent in training and more on their ability to demonstrate knowledge and skills. For example, the SCA requires only two units of CPE rather than four. Their certification process requires applicants to demonstrate their knowledge by passing a test about spiritual care (Handzo & Wintz, 2020). Applicants must also demonstrate their spiritual care skills by showing how they provide spiritual support to a simulated patient. The SCA has created a reasonable, evidence-based, and innovative approach to chaplaincy certification. Unfortunately, the rogue manner in which they went about establishing their association did not sit well with many chaplains and their reputation could use rehabilitation. It is a case of politics standing in the way of innovation backed by evidence.
The SCA should continue researching their certification process and publishing the results in peer-reviewed journals to show the efficacy of their process. The other major certifying bodies such as the Association of Professional Chaplains (APC) and the ACPE: The Standard for Spiritual Care and Education (ACPE) should do the same. Health care chaplains could then look to the evidence to determine which process is better and the certifying bodies could adapt accordingly guided by the evidence.