8th Annual Caring for the Human Spirit^® and The International Westberg Symposium Virtual Conference

Took Place on April 12-14, 2021

Below are highlights from the sessions:

Monday, April 12, 2021

Plenary: “Accelerating Change: The Emerging Future of Spiritual Care"

Rev. Kevin Massey
Vice President, Mission and Spiritual Care, Advocate Lutheran General Hospital

The provision of spiritual care needs to be examined along with all other areas of healthcare. The field of chaplaincy must study itself to learn what measureable outcomes of its work can be found.

• Surfing through a Sea Change: The Coming Transformation of Chaplaincy Training.
• Massey K. Reflective Practice: Formation and Supervision in Ministry. 2014.
• “The field of chaplaincy must study itself to learn what measurable outcomes can be found.”

Trends Underway at Advocate Aurora Health

• Fee for Service -> Fee for Value • Remote work
• Telemedicine
• Evidence-based medicine
• Alignment of care with values

COVID Changed Everything:

• System Discharges were -14.5% of budgeted for 2020
• That includes patients with COVID.
• Unknown what percent of those would have had a different hospitalization in 2020.
• If you take out patients with COVID the number changes to -30.6%
• 999,491 virtual visits in AAH in 2020.

Where do spiritual care providers do what they do?

Telemedicine:

• Doesn’t line up precisely with urban vs. rural.
• Shows care provided far outside the organization’s primary and secondary service areas.
• Illustrates the inequities of those who don’t have access to internet access

Chaplain Connect (current State) – Advocate’s Telechaplaincy

• 24/7 Chaplain Service of AAH
• Originally envisioned to pilot in Q4 2020
• Launched March 29th, 2020
• Envisioned for 24/7 back up coverage for rural places, ambulatory advance care planning, and team member support

Purposeful Rounding – Identifying achievable outcomes that contribute to the larger work of the organization

• Focuses chaplain care in the acute care hospital into clearer areas with achievable outcomes
  • Supporting patient/family coping to enhance compliance with treatment plan
  • Identifying inequities to be addressed with interdisciplinary team
  • Identifying misaligned care to be addressed with interdisciplinary team, increasingly planning to follow up about that in the post-acute stage.
  • Supporting emotional and spiritual needs of team members

What would it take to re-engineer a whole field?

• Recognition that the operating model has become obsolete
• Develop customer focused requesting model
• Focus attention outside the acute care hospital to pursue outcomes once person has been discharged
• Objectify the process of training and certifying spiritual care providers, and training and certifying spiritual care providers for the new present, not the obsolete past. Includes training in outpatient settings
• Re-envision the spiritual care delivery team (spiritual care providers includes inter-disciplinary team members as generalists, and chaplains and faith community nurses and ethicists and others as specialists)
• Codify a normative language and practice model

Keynote Address: Has COVID Made Us Better Caregivers?

Donna E. Shalala, PhD President Emeritus, University of Miam
Trustee Professor, Herbert Business School and Dept. of Political Science

The impact of COVID has led to rethinking the health care system, which was already known to be fragmented with issues of disparities, lack of access, etc. There have been serious issues due to COVID including mental health and loneliness. There are those who have stepped up within the pandemic to “care for the human spirit”. COVID has brought us closer together; it has also identified our gaps. Now is the time to knit together the health care pieces to create a new paradigm of compassion.

We have a generation of children who have issues of anxiety and parents who don’t know how to support them and are more concerned about the future.

Biden administration has proposed several increases:

• Mental health
• Child care
• Support to people who work in the health care system in terms of their mental health
• Senior care, particularly mental health
• Support to all those who work in health care

COVID will fundamentally change the ways in which we provide services, not only health-related but the social issues that surround it. Spirituality must be an essential part of all aspects of it.

Dialogue: Facilitated by George Handzo, APBCC with Questions from Attendees

HANDZO: Chaplains have not traditionally been involved in lobbying. If you were to say a few words to the public about spirituality, what would that be?

SHALALA: There are 2 asks: 1) Be at the table and integrated into the decision-making processes and systems, both health and social care. 2) Talk about how your work is integral to people’s health and wellness. It’s not simply expanding Medicare and Medicaid as filling in the gap – you are the gap. What do you provide? Speak up at the table.

HANDZO: If I were to write to one of my congressional reps, what would I write about?

SHALALA: Address salaries of those working the low-paid yet essential jobs in health care and ask for a broader role for those who provide care for the spirit.

HANDZO: What is in Congress now?

SHALALA: The real play is in the budget, so pay attention to the Appropriations Committee and their members who believe in social justice. The budget has been sent; the chair for the Infrastructure Bill budget is Rosa DeLauro (CT)

What supports the patient and the public? Think about fragmentation; the current health care system isn’t integrated. While one can talk about programs and salaries, look at meal programs, childcare, and all the programs that can lift people out of poverty and care for their needs. Learn about the programs that are in place and are being recommended

Nurses, pharmacists, and nursing assistants’ roles and scope of practice are being expanded. Expanding the role of health care professionals is happening – that is a state issue.

Have to become storytellers; congressional reps are interested in the stories of the people they represent.

HANDZO: What is the role of faith community nurses; is this a place where connection can help with the fragmentation?

SHALALA: Yes, it can be the glue. Approach: Some is licensure however educating everybody is the most important. Focus not only on end of life, but wellness because spirituality encompasses both. The day-to-day of life needs to be supported.

This will be the golden age of telemedicine and telehealth. During COVID, there was limits on touching. However, the 1:1 connection is just as important and needs to be expanded whether by computer or phone. It will change the practice of health care. “Just our ability to talk to people 1:1, especially for those who don’t have access to computers. It’s a new skill set for all of us.”

Bandwidth issues: President Biden will insist on this in the Infrastructure Bill. This is a major issue being pushed and supported as a bipartisan one and has support.

Home health care: Part of the President’s Budget includes expansion of home health care, which is primarily funded by Medicaid. These positions are severely underfunded and often do not include insurance or other opportunities to advance.

Inequities and hesitation about vaccines are all symptoms of mistrust in the health system. What should we be doing to help overcome this?

• • Listening, communicating, the compassion of the faith-based communities is key to getting people COVID vaccinated. “It’s only under emergency use by the FDA”. That doesn’t mean standards were lowered for approval; the same studies and requirements were followed. It was emergency-use approved to get it out quickly. The science had already been done.
  • Listen to concerns, ensure they have the facts. Make sure there are people within communities that work in the health care system who can talk about it. The most credible people are those that people know; they need to be part of the education.

HANDZO: State licensure for chaplains has been a hot-topic within the profession for years. Is that a good idea?

SHALALA: State licensure is often dictated by politics, not to do with red/blue states, but the medical societies within them. If it will give more access, yes – but wouldn’t spend time on it. Instead, create models for spiritual care for implementation into health systems and work to get them integrated.

Reimbursement funding hasn’t caught up and has met a dead end. That is both a state and federal issue. It’s an issue of broadening the standard of care and integrating spiritual/faith-based practitioners into the health care system as a way of providing wellness. Until some big health care systems step up (and where they have it has been successful), convincing the government to include spiritual-based care integrated into Medicare and Medicaid system bills, it will be uneven.

HANDZO: What can we do to educate more about equity, justice, cultural diversity issues so that they can become leaders?

SHALALA: These are clear social justice issues that many faith leaders have known for a long time; there is a lot of material available. Until everyone has access to quality health care and we can lift a generation of people out of poverty, we will not have social justice.

HANDZO: What do we know now and what can be accomplished in the Biden administration regarding COVID and its variants?

SHALALA: We are on top of the science; these vaccines need to cover the variants although we may need a one-shot booster shot next year like the flu. Public policy moves slowly; to make giant steps to help the country there has to be agreement on the problem and on the solution. We can expect “big things” to be done in Biden’s first two years, i.e. the Jobs Bill, to help improve communities.

HANDZO: What should chaplains and spiritual care providers do to help bridge the gap, or should we simply move ahead?

SHALALA: Closing the gap requires both the government and the faith-based communities, they can’t been seen as separate but integrated.

HANDZO: What helped sustain and nurture you through the pandemic?

SHALALA: What kept me grounded was regularly passing out food in the community, delivering meals to health care workers, having conversations, having a dog, talking to religious leaders in the community about their challenges, music of the faith communities.

HANDZO: We know that because of the pandemic, there will be grief and anxiety; how will these be addressed?

SHALALA: The president is encouraging a large increase in mental health for all, mental health services for health care providers, and investment in the next generation for mental health providers. We have also created a new kind of chronic disease: the COVID long-haulers, which needs to be addressed. We must worry about the work force of the future (including chaplains) as much as expanding current mental health programs, which means funding and strategies from Congress as is related to the high cost/high debt of higher education.

HANDZO: What about billing for services by chaplains and faith community nurses?

SHALALA: that is not particularly a federal issue but rather state-based.

HANDZO: What are other top issues in health care?

SHALALA: Health care has been shifting to outpatient for a long time. Public health and population-based health will be integrated into the system in a new way that hasn’t been seen before. There will also be a larger role for pharmacies and other stores to deliver health care in a way never seen before. Telemedicine as has been mentioned along with technology. The primary health care and the social safety net . Affordability of health care for all with a sense of fairness embedded. Finally, health care regulations have been historically layered upon each other and need to be simplified. Medicare is already doing this, especially within Medicare Advantage, which offers a broad range of services, reduces complexity for providers, and makes access simpler for patients.

Tuesday, April 13, 2021

Plenary: Providing Grief Support Using Technologies

Susan R. Jacob, PhD, RN
Executive Associate Dean and Professor, UTHSC College of Nursing; Faith Community Nurse

The pandemic has highlighted the critical role of providing support through technologies. Individuals have been isolated; separated from human contact with friends, family, and their faith community. Individuals have been separated from their loved ones who are hospitalized and dying. Funerals and memorial services have been postponed or cancelled. Grief experience and unresolved grief can lead to moral distress as providers encounter deaths that are countless, expected, unexpected, continuous in number, consecutive, and senseless.

Good Grief – Granger E. Westberg:

• We are in a state of shock
• We express emotion
• We feel depressed and very lonely
• We may experience physical symptoms of distress
• We may become panicky
• We feel a sense of guilt about the loss
• We are filled with anger and resentment
• We resist returning
• Gradually hope comes through
• We struggle to affirm reality

Grief Support through Technology: Phone, Text, Email, Virtual meetings using Zoom or Teams

Recommendations:

• Consider how you can use technology to transition in-person support\
• Consider how you can disseminate hard copy materials for education and support
• Consider providing hybrid options

Connecting with Others:

• Host conference calls
• Invite others to share memories via email, phone, video chat, group chat, or text messaging,
• Develop a memory book, blog, or webpage
• Form walking groups via a fitness app such as PACER

Free Online Resources:

• My Grief Angels – online grief and bereavement community; no fees, no mandatory sign ups
• Grief Anonymous – free online support options
• Online Grief Support – free social community; set up a profile and use many resources
• Facebook

Beware of the Dangers of Online Grief Support

• Before recommending an online group, be sure to check it out
• Secure private website
• Never give out personal information
• Legitimate groups usually do not require registration fees
• Be careful what you post
• Report suspicious behavior

GriefShare - https://www.griefshare.org/

• 13-week, faith-based, video-driven support group
• 40-minute video presentation
• Group discussion
• Workbook exercises
• Question and Answer
• Prayer

Weekly Seminar Topics

• Is This Normal?
• Challenges of Grief
• The journey of Grief
• Grief and Your Relationships
• Why?
• Guilt and Anger
• Complicating Factors
• Stuck
• Lessons of Grief
• Heaven
• What Do I Live For Now?

GriefShare Web Resources

• “Find a Group” Search Engine
• “A Season of Grief” Free Daily Emails@ griefshare.org/daily emails
• Healing From Grief
• Tell a Friend about GriefShare
• How to Help Grieving Children
• Start a Group
• Surviving the Holidays Website @griefshare.org/holidays
• Griefshare MPS DISC and Downloadable Audio Files @griefshare.org/audio
• Through a Season of Grief Devotional
• Grieving with Hope Book @griefshare.org/hope

GriefShare Leader Zone

• Log in and create account @www.GRIEFSHARE.ORG/LeaderZONE
• Password-protected website exclusively for leaders and church staff
• Downloadable forms and articles
• Promotional tools (videos, bulletin inserts, newspaper ads, sample letters)
• FAQs • Regional networking and training opportunities
• Online moderated Leaders’ Forum

Non faith-based groups

• Center for Loss and Life Transition
• Grief Beyond Belief
• Grief Recovery

Plenary: From Healthcare Trauma to Healthcare Trust: Spiritual Care for African Americans in the Face of Medical Apartheid

Rev. Danielle J. Buhuro, D.Min.ACPE
Certified Educator/CPE Supervisor, Advocate Aurora Health Care

Book Resource: Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Harriet Washington. 2008. Anchor. ISBN-10: 076791547X.

History of African American Health Care Oppression in the United States: Key Incidents and Experiments

• Beginning in 1619, medical doctors would partner with slave owners to “inspect” African slaves on the Auction Block before purchase.
• OBGYN doctors (J. Marion Sims) would partner with slave owners to administer experimental perinatal drugs to African slave women for the purpose of “breeding”/maximizing childbirths.
• Drapetomania, a mental illness condition created from medical research, diagnosing runaway African slaves as being diseased.
• Medical Research asserts African/African American inferiority and non-intelligence.
• The Immortal Life of Henrietta Lacks (1920-1951)
• The Tuskegee Syphilis Study (1932-1972)
• Margaret Sanger’s 1939 “Negro Project” (Planned Parenthood)
• In 1961, Civil Rights Activist Fannie Lou Hamer went to doctor to have a tumor removed from her uterus but instead she was given a hysterectomy without her consent. She’d later refer to this popular trending practice in the South as the “Mississippi Appendectomy”
• The Impact of Food Oppression
  • African Enslavement Food
  • Food Deserts

A Spiritual Care Approach: Caring for the Needs of the African American S.E.L.F.

• Social Needs
• Emotional Needs
• Life Meaning and Purpose Needs
• Faith (Religious) Needs

Oftentimes, as spiritual care providers, we start with theological/faith concerns first. We need to first address these needs in order, i.e. social needs first. To move from health care trauma to health care trust, African Americans need us to be concerned with their social and emotional needs first.

Caring for the African-American SELF in CPE Supervision During Two Pandemics: COVID-19 & Police Brutality. The Journal of Reflective Practice: Formation and Supervision in Ministry, Volume 41 (2021) https://journals.sfu.ca/rpfs/index.php/rpfs/index

Monnica Williams suggests that African Americans have PTSD due to overt/covert racism and experience numerous micro-aggressions. Managing Microaggressions: Addressing Everyday Racism in Therapeutic Spaces. Oxford. 2020. ISBN-10: 0190875232

African Americans may interpret their illness from 3 types of theological perspectives:

• Punishment from God/the Divine for sin committed or Karma.
• This illness is a test to overcome.
• Illness is part of life and has nothing to do with one’s relationship with God/the Divine either negatively or positively

The spiritual care provider must help persons reinterpret the theological perspective they are holding on to.

Show respect before jumping into addressing needs:

• Use surnames, i.e. Mr. Smith, rather than first names, particularly over the phone/Zoom
• Reduce background noise if doing a phone call
• Be relational; ask for one’s story

How to start a workplace conversation to raise awareness and understanding of systemic racism and how to address its health impacts

• Be sensitive to what is going in the world and have daily check-ins and/or debriefing sessions with African American staff
• Support more jobs for African Americans within one’s organization, including chaplaincy
• Honor religious and cultural events. What would it look like to host a special Juneteenth (June 19) event? (the official end date of slavery in the U.S. was June 19, 1865 – African American Emancipation Day)

Book: Spiritual Care in an Age of #BlackLivesMatter: Examining the Spiritual & Prophetic Needs of African Americans in a Violent America. Buhuro D. Cascade Books, 2019. ASIN : B081NYJJW4

Wednesday, April 14, 2021

Granger Westberg Memorial Lecture
Facing the Future: Human Compassion in Systems of Care

Anthony Sheehan, BSN, RN
President and CEO, Aspire Health Alliance

Faith Community Nurses, chaplains and other spiritual care health professionals are at the forefront of responding to a mental health crisis which has been exacerbated by the pandemic,

• COVID-19 has impacted emotional wellbeing: isolation, anxiety, children’s mental health, overdoses, loss and grieving
• For some, hopes and dreams took on a different, and more significant meaning
• COVID period connected to: Loss & grief, anxiety, depression, phobic conditions, SUD and more

Connecting people to compassionate care will be critical to our collective recovery, as will self-care. Now more than ever we need to understand that there can be no health without mental health.

Behavioral health (BH) conditions carry considerable human cost for affected individuals and families, including a decline in health status and life expectancy.

• Individuals with BH conditions lose more years to disability than those with any other condition
• Median reduction in life expectancy for individuals with mental illness is 10 years, for those with substance use disorders (SUF) it is 9-17 years
• More than one-third of adults who sought care in 2018 reported unmet treatment need – this number did not meaningfully change even for those insured for the entire year.

BH conditions are just as common than physical health problems

• Disabling: To often people with BH problems suffer with disabling physical conditions and die sooner than those without MH problems
• Early onset: BH problems often start much earlier in life than physical health conditions
• Unlike physical pain, people with BH problems often stay away when it really hurts

Normal anxiety involves a stimulates, an accurate interpretation of threat, anxious arousal to either fight, flight, or freeze. But anxiety can become distorted with there is a misinterpretation of a threat. Symptoms over time can include:

• Consistent for at least 2 weeks or more:
• Difficulty falling or staying asleep, or sleeping too much
• Loss of interest, pleasure in things once enjoyed
• Feelings of guilt, worthlessness and/or helplessness
• Fatigue and decreased energy
• Irritability/restlessness
• Slowed movement and speech
• Neglecting personal care (e.g., forgetting medications, neglecting personal hygiene
• Weight loss or weight gain, changes in appetite

Strategies to help prevent and reduce emotional challenges:

• Its not always easy, but a healthy lifestyle helps - take care of that heart! • Seek out the people you enjoy • Look back, notice that life can be stressful – “this too will pass” because “that did pass” • Be in the moment– avoid getting preoccupied with the things that can’t be controlled • Breathe – adopt stress reduction techniques • Allow yourself a second thought – a positive alternative • Work toward self-understanding and self-compassion • Ask for help - know that there are options if the pain continues

In terms of help, we know that:

• Treatment is effective
• Therapy really helps: talking therapy, art, music, meditation, peer support, groups
• There is good news! Early detection & intervention significantly improves treatment outcomes
• When people respond with compassion, hope and understanding those in need have a better chance

The negative mental health effects of COVID-19 are and will remain massive, far reaching, and long term. The cumulative toll of diagnosable illness fueled by wide exposure to loss, stress, and trauma, but also reflect more. Planetary sided ecological ruptures like this pandemic amplify structural disadvantage and a cascade of compounding risks and multiple vulnerabilities that all result in a deep and emotional damage.

Future conditions:

• Mental health and community wellbeing should be participatory, coalition-driven, hyperlocal work that permeates and engages all policies and the whole of society…non-clinicians and non-specialists as experts in local needs and co-owners of healing practices
• The growing field of task-sharing (which refers to the adoption of skills and tools by non-specialists, lay people, and peers to do much of the work of care, prevention, and promotion) needs to be scaled up and mainstreamed
• Specialist clinicians can be capacity-building partners and backup care providers for an array of other front-line workers. This framework, rather than the prevailing illness-driven specialist model, should be the starting point for building systems and policy that finally acknowledge that most of the mental and emotional suffering on the planet is driven by social conditions and choices that are under our control to change.

What can we do?

• Raise our awareness
• Training sessions
• Be prepared to respond
• Mental Health First Aid
• WISE accreditation or similar
• Hear the stories of our friends – don’t run away from them
• Take care of ourselves

“It seems ever more important than ever that we move beyond tolerance of difference to true and deep empathy with that which is other”. Diana Chapman Walsh

“If you do not listen to people when they whisper their prayers, you increase the risk of meeting them later when they are howling their cries”. James Billiington.