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Southern Medical Journal:
doi: 10.1097/01.smj.0000222404.81215.03
Special Section: Spirituality/Medicine Interface Project

Setting Common Standards for Professional Chaplains in an Age of Diversity

Snorton, Teresa E. MDiv, ThM, DMin., BCC

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From the Association for Clinical Pastoral Education, Inc.

Reprint requests to Rev. Dr. Teresa E. Snorton, MDiv, MTh, DMin., BCC, Executive Director, Association for Clinical Pastoral Education, Inc., 1549 Clairmont Road, Suite 103, Decatur, GA 30033. Email: teresa@acpe.edu

The training of chaplains and ministers in the United States has a long history. The story has its beginnings in the mid 1920s, when the new form of theological education known as Clinical Pastoral Education (CPE) was developed by Dr. William A. Bryan, Superintendent of the Worcester State Hospital, MA, who employed Rev. Anton T. Boisen, a former mental patient, to become the hospital chaplain. Boisen felt a calling to “break down the dividing wall between religion and medicine.” During that first summer program at Worcester State Hospital in 1925, the students served as ward attendants during the day, attended staff meetings, and in the evening participated in seminars with Chaplain Boisen and various members of the professional staff.1

Within five years, the CPE movement had evolved into an organization, The Council for Clinical Training of Theological Students, under the leadership of both physicians (Richard Cabot, Helen Flanders Dunbar) and ministers (Boisen, Philip Guiles, Bishop Henry Hobson, Carroll Wise, Seward Hiltner, Russell Dicks and many others). Within a few years, another organization, the Institute for Pastoral Care, was founded by some of the original developers of CPE.

Since 1967, the Association for Clinical Pastoral Education has been the premier provider of CPE programs in the United States. The ACPE, Inc. was founded that year through the merger of The Council for Clinical Training of Theological Students, the Institute for Pastoral Care, the Lutheran Advisory Council and the Southern Baptist Association for Clinical Pastoral Education. In 2006, the ACPE, Inc. has over fifty 350 accredited programs and satellites throughout the United States. Annually, the ACPE offers over 6,500 units of training to theology students, ministers and other clergy, lay persons, and health care professionals who have an expressed interest in the interface of spirituality and health. ACPE is a multicultural, multifaith organization with over 600 ACPE certified faculty members (called CPE Supervisors). There are 117 Theological School Members and 23 Faith Groups and Agencies who are partners with ACPE in seeking to provide excellence in theological education.

CPE, described by Edward Thornton as “professional education for ministry,” presented a radical juxtaposition of the behavioral sciences with theology. The early developers of CPE wanted to create a “controlled laboratory” for theology students to learn the practice of ministry. The methodology is “developmental, existential, and phenomenological.”2 Current language describes this clinical method as the “action-reflection” model. CPE students provide pastoral care and counseling to persons in hospitals, hospices, long-term care facilities, mental health facilities, correctional centers, and group homes. Students then attend didactic seminars on topics related to the context and make case presentations in small learning groups.

Since the beginning, the CPE movement has always been concerned about standards and competence. In 1947, the CPE groups began a peer-reviewed professional journal, The Journal of Pastoral Care and Counseling. In 1951, the groups began meeting together to create standards for accreditation programs, as well as standards for the training and certification of faculty. In 1967, the ACPE, Inc., was first recognized by the United States Department of Education as an accreditor of CPE, and has continued to be recognized as such.

The ACPE standards define the minimum components required for every accredited program of CPE, and include objectives and outcomes for Level 1, Level 2, and Supervisory CPE. For example, some of the program standards are:

* A specific time period for a program unit of clinical pastoral education. A unit of CPE is at least 100 hours of structured group and individual education. Each unit shall be accompanied by the supervised clinical practice in ministry. The combined time shall be no less than 400 hours.

* A relational learning environment that fosters growth in pastoral formation, pastoral reflection and pastoral competence; such an environment involves mutual trust, respect, openness, challenge, conflict, and confrontation.

* An instructional plan that employs a process model of education and a clinical method of learning including: 1) delineation and use of students' goals; 2) core curriculum appropriate to the CPE setting.

Sample educational outcomes for CPE include the ability to:

* Articulate the central themes of one's religious heritage and the theological understanding that informs one's ministry.

* Initiate peer group and supervisory consultation and receive a critique of one's ministry practice.

* Provide pastoral ministry to diverse people, taking into consideration multiple elements of cultural and ethnic differences, social conditions, systems, and justice issues without imposing their own perspectives.

* Demonstrate a range of pastoral skills, including listening/attending, empathic reflection, conflict resolution/confrontation, crisis management, and appropriate use of religious/spiritual resources.

* Assess the strengths and needs of those served, grounded in theology and using an understanding of the behavioral sciences.

* Manage ministry and administrative function in terms of accountability, productivity, self-direction, and clear, accurate professional communication.

* Demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self-disclosure, positive use of power and authority, a nonanxious and nonjudgmental presence, and clear and responsible boundaries.3

In 2004, the ACPE, Inc. and five other professional pastoral care certifying and educational organizations in North America adopted a Common Code of Ethics and Common Standards for Professional Chaplaincy, Pastoral Educators and Supervisors.

The collaborating groups include the ACPE, Inc., the Association of Professional Chaplains (APC), an interfaith certifying group, the National Association of Catholic Chaplains (NACC), the National Association of Jewish Chaplains (NAJC), the American Association of Pastoral Counselors (AAPC) and the Canadian Association for Pastoral Practice and Education (CAPPE/ACPEP). These combined groups represent over 10,000 members who currently serve as chaplains, pastoral counselors, and clinical pastoral educators in specialized settings as varied as healthcare, counseling centers, prisons and the military.”4

By adopting common standards and ethics, the Council on Collaboration has further defined the benchmarks for excellence in the field, as well as the competencies that any professional, certified pastoral caregiver should be able to demonstrate. These unified definitions are intended to protect consumers from the well-intended, but untrained. “Trained, certified chaplains come from every faith and denomination, but they never proselytize among patients or their families. Instead, their job is to listen respectfully to the spiritual worries, fears or anger of those they serve.”4 The extensive CPE training required (a minimum of four units of CPE or 1,600 hours is the prerequisite for board certification) equips chaplains to deal with a variety of crisis situations, to respond to persons in a pluralistic, multicultural society with sensitivity and compassion, as well as to function with a multidisciplinary team in institutional settings.

Examples of the kind of competencies required for chaplaincy certification include:

* Articulate a theology of spiritual care that is integrated with a theory of pastoral practice.

* Incorporate a working knowledge of psychological and sociological disciplines and religious beliefs and practices in the provision of pastoral care.

* Incorporate the spiritual and emotional dimensions of human development into the practice of pastoral care.

* Function pastorally in a manner that respects the physical, emotional, and spiritual boundaries of others and uses pastoral authority appropriately.

* Communicate effectively orally and in writing. Present oneself in a manner that reflects professional behavior, including appropriate attire and personal hygiene.

* Establish, deepen and end pastoral relationships with sensitivity, openness, and respect.

* Provide pastoral care that respects diversity and differences including, but not limited to culture, gender, sexual orientation, and spiritual/religious practices.

* Triage and manage crises in the practice of pastoral care.

* Provide pastoral care to persons experiencing loss and grief.

* Formulate and utilize spiritual assessments to contribute to plans of care.

* Provide religious/spiritual resources appropriate to the care of patients, families and staff.

* Develop, coordinate and facilitate public worship/spiritual practices appropriate to diverse settings and needs.

* Establish and maintain professional and interdisciplinary relationships.

* Support, promote, and encourage ethical decision-making and care.

* Document one's contribution of care effectively in the appropriate records.

* Foster a collaborative relationship with community clergy and faith group leaders.

The emphasis throughout the Common Standards is the appropriate preparation and demonstration of the ability to function without bias, as a member of a team, with an awareness of diversity and difference, and with integrity. With these Common Standards in place, “certified chaplains from every association must now have theological education at the graduate level and advanced clinical training to prepare them for intense ministry in specialized settings.”4

The ACPE and several of the Council on Collaboration organizations have worked closely with the American Red Cross (ARC) in disaster preparedness and response and with the National Transportation Safety Board in helping the ARC develop standards for providing competent and ethical nonsectarian spiritual care following air disasters. Those same guidelines for spiritual care were used by the Red Cross in its response to the 9/11 attack. Many of the chaplains who responded to the Gulf Coast disaster following Hurricanes Katrina and Rita were trained by ACPE and certified by APC, NACC, NAJC, or AAPC. They were able to provide spiritual care with an appreciation for the diversity of cultures represented among the evacuees. Certified, trained chaplains and supervisors also staff many of the hospitals that received patients and victims from the hurricane ravaged areas.

Our rigorous standards and curriculum train chaplains to function in crisis situations with respect and honor for the religious beliefs of those affected by illness, crisis and disaster. In this age of diversity, it is important that chaplains are able to recognize the healing value in a variety of faith expressions, without imposing their own religion or spirituality on people in crisis situations. Through CPE training, these competencies are not only developed, but monitored through on-going peer review processes and annual continuing education requirements within the certifying associations.

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References

Figure. Teresa E. Sn...
Figure. Teresa E. Sn...
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1. Association for Clinical Pastoral Education, Inc. Available at: http://www.acpe.edu. Accessed May 7, 2006.

2. Thornton EE. Professional Education for Ministry, Nashville, Abingdon Press, 1970.

3. Association for Clinical Pastoral Education, Inc. Standards of the Association for Clinical Pastoral Education, Inc. 2005. Available at: http://www.acpe.edu. Accessed May 7, 2006.

4. Association for Clinical Pastoral Education, Inc. Chaplains' groups agree on common standards. Available at: http://www.acpe.edu/council.htm. Accessed May 7, 2006.

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Resources
Gerkin C. An Introduction to Pastoral Care. Nashville, Abingdon Press, 1997.
Hall CE. Head and Heart: The Story of the Clinical Pastoral Education Movement. Journal of Pastoral Care Publications, 1992.
Hemenway JE. Inside the Circle. Journal of Pastoral Care Publications, 1995.
Holifield EB. A History of Pastoral Care in America, Nashville, Abingdon Press, 1983.
Patton J. Pastoral Care in Context: An Introduction to Pastoral Care. Louisville, Westminster/John Knox Press, 1993.
Powell R. Fifty Years of Learning: Through Supervised Encounter With Living Human Documents. The Association for Clinical Pastoral Education, 1975.
Stokes A. Ministry After Freud New York, The Pilgrim Press, 1985.
Summers T. Hunkering Down: My Story in Four Decades of CPE Columbia, Edisto Press, 2000.
Thomas JR. A Snap Shot History of the Association for Clinical Pastoral Education Inc. Decatur, Association for Clinical Pastoral Education Inc., 2005.

Our lives begin to end the day we become silent about things that matter. - —Martin Luther King, Jr.

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