• How long does the process take?
Every applicant is unique and personal circumstances vary. The length of time from application submission to approval/rejection takes an estimated 4 to 6 months. The timeline is mainly dictated by the candidate’s readiness to take the test and availability to be scheduled for the exam.
• How many types of certification does SCA offer?
SCA offers three types of certification: Advanced Practice Board Certified Chaplain (APBCC, Board Certified Chaplain (BCC), and Credentialed Chaplain (CC). In addition, SCA offers a Spiritual Care Generalist Certificate for candidates interested in becoming spiritual care generalists.
• What is APBCC?
An Advanced Practice Board Certified Chaplain (APBCC) has demonstrated advanced skills in the provision of and leadership in spiritual and chaplaincy care by successfully completing a standardized test of core knowledge derived from evidence-based quality indicators for spiritual care as well as a simulated patient exam that evaluates competency in direct patient care. APBCC chaplains have been trained and tested in standardized curriculum based on the latest evidence in areas including department management, HIPAA regulations, the assessment, diagnosis and treatment of spiritual distress, cultural competency, advance care directives, patient clinical care, staff support, grief, and bereavement among other essential topics.
• What is the process of Certification or Credentialing like?
If you haven’t already done so, you must first become a member of the Spiritual Care Association.
After carefully reviewing the requirements for the certification you are seeking, begin an online application (please note you must be logged in in order to begin an application).
Submit your application online along with all the required supporting documents. You will receive an email once your application and documents have been reviewed and accepted. At this point, you are “pre-approved” to continue to the next phase.
Next phase: you will need to complete (1) the Standardized Clinical Knowledge Test, and (2) the Standardized Patient Exam through a simulated patient encounter. You will have 6 months to successfully pass both the test and the exam (the 6 months begin from the day you receive notification that your documents have been accepted). You can take the test and exam in any order.
• What is the application fee?
The non-refundable application fee is $300 for APBCC; $300 for BCC (or $150 if you are already BCC with another recognized organization); and $275 for CC.
• How much are the annual maintenance fees?
Advanced Practice Board Certified Chaplains (APBCC), Board Certified Chaplains (BCC) and Credentialed Chaplains (CC) need to pay annual maintenance fees to maintain their APBCC, BCC and CC. The annual maintenance fee is $150. Maintenance fees are due annually every January. You will be invoiced January 1st of each year for that calendar year.
Please note: for your first year, your maintenance fees are pro-rated for that particular year. The fees are due upon becoming certified.
• What are the continuing education requirements (CEs) to maintain Certification or Credentialing?
To maintain Advanced Practice Board Certification (APBCC) status, 30 continuing education hours are required every year. To maintain Board Certified Chaplain (BCC) status, 24 continuing education hours are required every year. To maintain Credentialed Chaplain (CC) status, 12 continuing education hours are required every year.
• Is membership in SCA required?
Yes. Current membership in SCA is required for all three types of certification: APBCC, BCC, and CC.
• Who should I contact if I have questions during the process?
Standardized Clinical Knowledge Test
• In what time period do I have to take the test?
You will have 6 months starting on the day you receive your login credentials to take the test. You will receive your login credentials (and instructions) after your documentation has been accepted. We will notify you via e-mail.
• Is the test timed? How many questions are on the test? What constitutes a passing score?
The APBCC Test has 100 questions. You will have 120 minutes to complete the test. A passing score is 75% or higher.
The BCC Test has 85 questions. You will have 100 minutes to complete the test. A passing score is 75% or higher.
The CC Test is 85 questions. You will have 100 minutes to complete the test. A passing score is 65% or higher.
• What topics are covered in the test?
We have prepared a very thorough overview of what is covered in the test. You can find this information in this document’s Appendix 2: What’s in the Test.
• Do you offer a preparation course for the test? What is the cost?
Yes, SCA offers a preparation course called, Preparation for Standardized Clinical Knowledge Test for Board Certified and Credentialed Chaplains. Please note: it is not a requirement to purchase this course for certification or credentialing.
• What happens if I fail the test?
If you fail the test, you will be allowed to retake the test one more time at no additional cost to you. If you fail the test again, you may retake the test again for a fee of $75. There are no limits to the number of times to retake the test. However, all the re-takes must take place within the 6-month deadline.
• Who gets a copy of my test score?
The test taker and SCA’s certification director are the only two people who receive notification of the test score. Test scores are not shared with anyone else.
• When do I find out if I passed or failed?
Once you have completed the test, your grade will be displayed to you. You will also be notified by an SCA Certification Administrator as to the results of your test. Please note: we are not able to send reports of the test to you.
• What is your Accommodation Policy?
• How were the questions and answer options on the test developed?
It is very important to understand that the questions and the answer options are based on the evidence in the field. That is, every correct answer is evidence-based which means it is supported by research, guidelines or expert opinion. This evidence may not conform to the way you have thought or done things or even how your institution does things. Put another way, you should answer each question based on what the evidence says rather than based on what you think is the right answer. Thus, your chances of passing the test will be significantly improved if you make sure you are familiar with the literature we have suggested.
Standardized Patient Exam
• Do I have the option of writing a verbatim instead of doing a Standardized Patient Exam?
No. Only candidates that submitted an application prior to June 1, 2017 were allowed to submit a verbatim in lieu of doing a Standardized Patient Exam. The Standardized Patient Exam (live, online visit with a simulated patient) is part of the requirements for credentialing (CC), board certification (BCC), and advanced practice board certification (APBCC).
• What is the Standardized Patient Exam?
The Standardized Patient Exam is a simulated patient encounter that will be scheduled in advance with the candidate and will be done remotely using a computer application called Zoom (similar to Facetime or Skype). Zoom is a widely used free application that will easily run on any computer. Your computer needs to have a camera. You will also need access to a speaker phone in order to participate (alternatively, if your computer has a microphone, you can use that as well as your audio). The candidate can participate in this exam from any location where he/she can have privacy and quiet.
At the start time for the session, the candidate will be presented with the text of a referral that mimics the kinds of referral a chaplain tends to receive in normal practice. The referral will be for a situation that requires an immediate visit. About five minutes later, the client, who might be a patient or a caregiver, will join the call, and the chaplain will commence the encounter (visit) as he/she normally would. The client will be played by a professional actor who has thoroughly studied extensive information about the person he/she is portraying. The candidate will have 20 minutes for the encounter. Within 30 minutes of the close of the encounter, the candidate will submit a chart note on the encounter using the criteria on the scoring sheet. The encounter will be scored by the simulated patient and by two or three senior chaplains.
• How do I get scheduled to take the Exam?
After your application and documents have been accepted, you will receive an email from an SCA Certification Administrator with several dates to choose from to be scheduled to take the exam. You must select one of these dates. Failure to select a date within the 6-month period will constitute a failed exam. Likewise, a no-show during your exam date will also constitute a failed exam.
• What happens if I fail the Exam?
If you fail the Exam, you will be allowed to re-take the Exam; however there will be a fee of $100. To re-take the Exam, you will also be given up to three dates to choose from. You will have to choose from one of the dates offered. Failure to show-up for a scheduled exam will be considered a failed exam and the re-take fee will apply.
• Does it matter which I do first: the test or the exam?
No. You need to complete both successfully with the 6-month timeline, but it does not matter in which order.
The specific behaviors below are particulars of an overall relational presence, demonstrated clinical acuity, and attitude that scorers will be looking to see the chaplain exhibit. This attitude has been variously called pastoral caring or caring for the human spirit.
The chaplain is expected to exhibit within the visit only those behaviors that are appropriate to the case and avoid behaviors that might be inappropriate to the case.
Does the chaplain exhibit an evident sense of deep caring for the patient or caregiver's human predicament? Is this attitude clearly therapeutic in the sense of effecting a relationship where the person feels accepted and understood by the chaplain? Does the engagement contribute to the person(s) having a greater sense of comfort, acceptance—even for the unacceptable; connected to self and others, and even a sense of wellness, wisdom and peace? Finally, does the chaplain use his/her clinical acuity in a caring way to move some or all these goals forward?
|Chaplain introduced him/herself and explained the purpose of the visit.|
|Chaplain used culturally appropriate language.|
|Chaplain demonstrated active listening.|
|Chaplain demonstrated supportive responses.|
|Chaplain used appropriate nonverbal practices, including:|
|a. Maintaining eye contact as is culturally appropriate|
|b. Maintaining appropriate posture|
|c. Using appropriate tone of voice|
|Chaplain exhibited appropriate attire and hygiene|
|Chaplain demonstrated respect for the dignity and worth of the patient/caregiver.|
|Chaplain did not impose his/her doctrinal positions spiritual practices on the patient/caregiver.|
|Chaplain respected the spiritual/emotional/physical boundaries of the patient/caregiver|
|Chaplain acknowledged religious and cultural cues in a nonjudgmental manner.|
|Chaplain assessed as appropriate the importance of religion, spirituality, existential, and cultural beliefs and values for the patient/caregiver.|
|Chaplain assessed as appropriate for spiritual/religious/existential/cultural needs, hopes and resources.|
|Chaplain established a relationship in which the patient/caregiver verbalizes their issues and concerns.|
|Chaplain summarized the visit for the patient/caregiver and lets him/her know what follow up to expect from the chaplain or other appropriate health care team members|
|Chaplain documented a spiritual/pastoral assessment of the patient/caregiver and a spiritual/pastoral care plan including culturally appropriate, evidence-based interventions for both the chaplain and other members of the health care team, expected outcomes, and any referrals to other members of the health care team while holding confidential material not appropriate or necessary to be shared.|
|Chaplain introduced him/herself and explained the purpose of the visit.|
|Chaplain used language that I understood.|
|Chaplain used language that was respectful of who I am.|
|Chaplain listened closely to me and paid attention to what I was saying.|
|Chaplain's responses to me were supportive and helped me talk further about my situation.|
|Chaplain seemed like he/she was really focused on me and my concerns.|
|Chaplain's tone of voice put me at ease and helped me talk about my concerns.|
|Chaplain treated me with respect.|
|Chaplain accepted my spiritual beliefs and practices and did not try to impose his/her beliefs on me.|
|Chaplain helped me talk about my concerns and fears.|
|After chaplain's visit, I felt better able to deal with my situation.|
|After chaplain's visit, I felt less distressed.|
The following is intended as an overview for persons preparing for the Standardized Clinical Knowledge Test as required for Advanced Practice Board Certification (APBCC), Board Certification (BCC) or Credentialing (CC) by the Spiritual Care Association.
For many years, chaplains have been allowed and even sometimes encouraged to develop their own style or process. Part of this came from the fact that there was no evidence for best practice in the field. That situation has fortunately changed. SCA and this test are focused, not on what you or I or your institution do or think, but on what the published guidelines, research and expert opinion in the field generally say should be done. This change brings us into alignment with other health care disciplines. As an example, while your institution for very good reasons may emphasize readmission rates their as primary quality metric, that metric is not considered a major driver of health care value and quality nationally. A review of the literature would support that. Likewise, some choices to some questions are close in content. However, all of them are clearly differentiated in the literature. The material in this document gives some direction on literature you should be familiar with before you take the test.
The Spiritual Care Association Learning Center has a full course available, Preparation for Standardized Clinical Knowledge Test, which provides more in-depth preparation, articles and resources to assist candidates in preparing for the Standardized Clinical Knowledge Test.
By the end of the course, the learner will be able to:
While many books can be useful as part of a chaplain’s education, the following are considered to be essential foundational texts that every chaplain should read, have in his or her library, and be able to discuss and integrate into his or her practice. For those desiring to complete the Standardized Clinical Knowledge Test for Board Certification or Credentialing, these two texts are invaluable:
Additional helpful texts are listed at the end of this guide.
The questions in the Standardized Clinical Knowledge Test are developed from the following learning objectives. A test candidate may wish to focus specifically on those topics for which he or she wants to refresh his or her knowledge base or read more about unfamiliar concepts. (We have marked in red those learning objectives that apply only to Advanced Practice Board Certification.)
To locate articles, many health care settings have libraries available to staff that might include the journals that include these articles, and/or have resources that can locate sources for them. In addition, there are websites to become familiar with in order to do your own literature search for either a specific article or topic. Typing in the name of the article or topic into a web search engine will typically give you several options to find the full article or an abstract.
The following sites may also be helpful to test candidates:
Further preparation for the Standardized Clinical Knowledge Test may also be undertaken by finding courses and in-services with topics that the candidate may not be familiar and desires more study on. Universities offer both in-person and online courses for credit and to audit. In addition, webinars, conferences, and other educational events through health care-related professional associations or other providers may address topics of interest. Full courses are available at the Spiritual Care Association Learning Center for those who may wish to study more in-depth in certain competencies covered by the Standardized Clinical Knowledge Test. Click on each course title listed on the website for a more in-depth description of the course. Each course description in the Learning Center identifies each Quality Indicator foundational to the test that is addressed in the course.
It is essential for test candidates to have basic knowledge of what evidence-based health care is in order to understand the rationale behind evidence-based competency and the standardized clinical knowledge testing process as well as to improve their own chaplaincy practice.
Evidence-based practice (EBP) improves health care quality, reliability, and patient outcomes as well as reduces variations in care and costs. (Melnyk, et al. 2014). The most common definition of EBP is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996). It includes the conscientious, explicit and judicious use of current best evidence in making decisions regarding the care of individual patients. (Kang. 2016).
It is the professional responsibility of chaplains to apply the best scientific evidence for designing and implementing spiritual care assessments, interventions and outcomes into the spiritual components of care plans, and integrate the accessible research evidence into their decision making. (Duke University Medical Center Library. 2014).
The evidence-based process which leads to practices decisions is defined by its founders as a process that involves “the integration of best research evidence with clinical expertise and patient values” (Sackett et al. 2000). The evidence, by itself, does not make the decision, but it can help support the patient care process. The EBP process acknowledges the importance of both clinical expertise and client characteristics/values, along with the consideration of the best available evidence when making practice decisions. (Ruben and Parrish. 2011).
Evidence-based practice (EBP) has been discussed at various times throughout the history of professional chaplaincy and has occasionally appeared in articles (O’Connor and Meakes. 1998; O’Connor 2002) and documents released by professional chaplaincy organizations (Association of Professional Chaplains. 2009.) However, there was little information about, resources for, or testing to establish how chaplains understood EBP and outcomes into their practice. Some studies indicated that some chaplains were uncertain about how EPB would enhance their practice (O’Connor. 2005), while others were simply resistant to learning about it and/or incorporating it. (Lewis. 2002).
In 2014, Chaplain Researcher George Fitchett and his colleagues undertook a study to examine chaplains’ attitudes and practices with respect to evidence-based chaplaincy care. The study data came from surveys of health care chaplains working in the Department of Veteran Affairs, the Department of Defense, and civilian settings. Chaplains from all three settings strongly endorsed an evidence-based approach to chaplaincy, although, interestingly, “a larger proportion of civilian chaplains were skeptical that chaplaincy care and chaplaincy outcomes could be measured.” Four moderate to major barriers were identified:
Fitchett and his colleagues identified several conclusions in their study, the most important of which was that all chaplains, in order to apply EBP “will be required to develop research literacy so they have the ability to critically examine and integrate the results of research into their professional practice” (Fitchett and Grossoehme. 2012). They also concluded that the findings of the study have implications for chaplain training and continuing education.
Reading: Evidence-Based Chaplaincy Care: Attitudes and Practices in Diverse Healthcare Chaplain Samples. Fitchett, Nieuwsma, et.al. 2014.
In 1998, Chaplain John Gleason argued that health care chaplaincy was entering a new paradigm as a “response to individual need” in light of changes in health care, including intentional models for spiritual assessment and attention to outcomes and research. Pay-for-performance (P4P) entered the U.S. health care payment system in 2005, providing financial incentives to hospitals, physicians, and other providers to improve the quality, efficiency, and overall value of care in order to achieve optimal outcomes for patients. Gleason identified strong implications for chaplains, including the need to identify more evidence-based practices. (Gleason. 2012).
In 2005, Gleason initiated An Ideal Intervention Paper project to consolidate the learnings of clinical pastoral education students, which were then collected over a period of seven years. (Gleason. 2013). The goal was to create a knowledge base for effectiveness research in order to identify replicated effective interventions to designate evidence-based best practices in spiritual care, and a pilot effectiveness study of samples was undertaken.
Reading: The Ideal Intervention Project Explained. Sharing Spiritual Care Knowledge for the Good of All. Gleason JJ. 2011. National Association of Catholic Chaplains Conference.
Numerous other chaplains have written articles contributing to the call for evidence-based chaplaincy practice. A test candidate can utilize the literature search information described earlier to find articles to add to one’s knowledge. Examples include:
In developing the Standardized Clinical Knowledge Test, the foundational documents were the Quality Indicators and Scope of Practice published in 2016, which relate to the most comprehensive evidence-based information that demonstrates the quality and practice of spiritual care. The Quality Indicators and Scope of Practice were developed by two international, multidisciplinary panels of experts in the field that were convened by HealthCare Chaplaincy Network.
Numerous evidence-based professional articles from a variety of disciplines were utilized. This model allows for updates to the standardized knowledge testing, curriculum made available through the Spiritual Care Association Learning Center, and ultimately the Scope of Practice as research continues to identify best practices and evidence for the provision of expert spiritual care to individuals, families and staff.
Test candidates will want to download and become familiar with these three documents.
What Is Quality Spiritual Care in Health Care and How Do You Measure It? provides:
The Scope of Practice document articulates the scope of practice that chaplains need to effectively and reliably produce quality spiritual care. It follows on the work of the evidence-based Quality Indicators document, establishing what chaplains or spiritual care professionals need to be doing to meet those indicators and establish evidence-based quality care.
The competencies within the Scope of Practice provide specific examples of what a professional chaplain’s knowledge base should be in order to provide the most effective care to meet the Quality Indicators.
Structural Indicators refer to the ways in which a health care organization and chaplaincy department ensure a framework is in place and followed in order to provide and promote quality spiritual care for patients/clients, families and staff.
Structural Indicator 1.A.
1.A. Quality Indicator: Certified or credentialed spiritual care professional(s) are provided proportionate to the size and complexity of the unit served and officially recognized as integrated/embedded members of the clinical staff. (Handzo G and Koenig. 2004; Wintz and Handzo 2005)
1.A. Metric: Institutional policy recognizes chaplains as official members of the clinical team.
1.A. Suggested Tool: Policy review
1.A. Competencies (from Scope of Practice. HCCN.2016)
Structural Indicator 1.A. What Do I Need to Know?
Test candidates need to be familiar with the best-practice knowledge and skills needed to advocate within a health care setting. This includes a wide range of issues as indicated in the competencies. A major mistake that many chaplains and their departments make is to plan their department's program in isolation from other stakeholders within their organizational setting; however, the issues of planning, policies and procedures, regulatory guidelines, being a leader and advocate for spiritual care within the organization, how to work with both management and other members of the intradisiciplinary team, being able to articulate the goals of chaplaincy/spiritual care and how they integrate into treatment plans are essential whether one is a staff chaplain or a department director.
Reading: Intradisciplinary Spiritual Care for Seriously Ill and Dying Patients: A Collaborative Model. (Puchalski C, et. al. 2006)
Structural Indicator 1.A Sample Question
According to Puchalski’s 2006 model for intradisciplinary spiritual care, all professionals on the health care team participate in providing care to the patient. What two critical elements does she include in this model?
Correct answer: b. Source: Intradisciplinary Spiritual Care for Seriously Ill and Dying Patients: A Collaborative Model. (Puchalski C, et. al. 2006)
Structural Indicator 1.B.
1.B. Quality Indicator: Dedicated sacred space is available for meditation reflection and ritual. (The National Consensus Project for Quality Palliative Care. 2013)
1.B. Metric: Yes/No
1.B. Suggested Tools: N/A
Structural Indicator 1.B. Competency
The chaplain advocates effectively for the allocation and equipping of dedicated space for meditation, reflection and ritual, taking into account the particular cultural, ethnic and religious needs of the community.
Reading: Sacred Spaces in Public Places: Religious and Spiritual Plurality in Health Care. (Reimer-Kirkham, et al. 2012).
Structural Indicator 1.B. What Do I Need to Know?
Test candidates should understand the important elements to be taken into consideration when designing sacred space within their institutional setting, including steps to be taken to capture the demographics of the patient population cache to ensure representation of cultural, ethnic, religious, spiritual and existential beliefs and values.
Structural Indicator 1.B Sample Question
Sacred spaces within health care institutions need to:
Correct answer: c. Source: Sacred Spaces in Public Places: Religious and Spiritual Plurality in Health Care. (Reimer-Kirkham, et al. 2012).
Structural Indicator 1.C.
1 C. Quality Indicator: Information is provided about the availability of spiritual care services. (National Quality Forum. 2006).
1 C. Metric: Percentage of patients who said they were informed that spiritual care was available.
1 C. Suggested Tool: Client satisfaction survey
Structural Indicator 1.C. Competencies
Structural Indicator 1.C. What Do I Need to Know?
Test candidates will need to have the knowledge required to communicate the availability and description of chaplaincy/spiritual care services within a health care setting, including what elements are important to be aware of and include in planning, execution and evaluation.
Reading: Relationship Between Chaplain Visits and Patient Satisfaction. (Marin D, et al. 2015).
Structural Indicator 1.C. Sample Question
One reason the availability of chaplaincy services is an important element for patients and families to be aware of is because studies demonstrate that:
Correct answer: c. Source: Relationship Between Chaplain Visits and Patient Satisfaction. (Marin D, et al. 2015).
Structural Indicator 1.D.
1. D. Quality Indicator: Professional education and development programs in spiritual care are developed for all disciplines on the team to improve their provision of generalist spiritual care. (Pulchaski C, Ferrell B, et.al. 2009)
1. D. Metric: All clinical staff receive regular spiritual care training appropriate to their scope of practice and to improve their practice.
1. D. Suggested Tools: Lists of programs, number of attendees, and feedback forms
Structural Indicator 1.D. Competencies
Structural Indicator 1.D. What Do I Need to Know?
Test candidates should have a knowledge of intradisciplinary teams, particularly the importance of the presence and functions of both generalist and specialist spiritual care providers. In addition, candidates should have knowledge of how chaplaincy fits into the intradisiciplinary team structure, communication within teams, and how to articulate the contributions of the chaplain as the spiritual care specialist.
Reading: Collaborating with Chaplains to Meet Spiritual Needs. (Grossoehme D and Jacobson A. 2006).
Structural Indicator 1.D. Sample Question
A key component of an intradisciplinary infrastructure to address patient spiritual needs is for spiritual care generalists to know:
Correct answer: a. Source: Collaborating with Chaplains to Meet Spiritual Needs. (Grossoehme D and Jacobson A. 2006).
Structural Indicator 1.E.
1.E. Quality Indicator: Spiritual care quality measures are reported regularly as part of the organization's overall quality program and are used to improve practice. (Arthur J. 2011).
1.E. Metric: List of spiritual care quality measures reported
1.E. Suggested Tools: Audit of organizational quality data and improvement initiatives
Structural Indicator 1.E. Competencies
Structural Indicator 1.E. What Do I Need to Know?
Test candidates should possess the fundamental knowledge, processes and practices associated with quality improvement projects and the process for conducting research within and about professional chaplaincy.
Reading: An Invitation to Chaplaincy Research: Entering the Process. (HealthCare Chaplaincy Network. 2014.)
Structural Indicator 1.E. Sample Question
“Satisfaction with overall care” is an example of what component in research methodology?
Correct answer: b. Source: An Invitation to Chaplaincy Research: Entering the Process. (HealthCare Chaplaincy Network. 2014.)
Process indicators refer to actions undertaken by chaplains and the chaplaincy department as the second part of a framework consistently followed to provide and promote quality spiritual care for patients/clients, families and staff.
Process Indicator 2.A.
2. A. Quality Indicator: Specialist spiritual care is made available within a time frame appropriate to the nature of the referral. (Pulchaski C, Ferrell B, et.al. 2009.)
2. A. Metric: 1) Percentage of staff who made referrals to spiritual care and report that the referral was responded to in a timely manner, and 2) Percentage of referrals responded to within chaplaincy services guidelines.
2. A. Suggested Tools: 1) Survey of staff, and 2) Chaplaincy data reports
Process Indicator 2. A. Competency
The chaplain integrates effective and responsive spiritual care into the organization through policies and procedures, use of evidence-based assessment and documentation processes, and education of the interdisciplinary team about spiritual care.
Process Indicator 2. A. What Do I Need to Know?
Test candidates should have knowledge of the theories and evidence that provide effective foundational policies, procedures and processes to establish and integrate chaplaincy care throughout a health care organization.
Reading: Handzo G. The Process of Spiritual/Pastoral Care: A General Theory for Providing Spiritual/Pastoral Care Using Palliative Care as a Paradigm. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2. A. Sample Question
Chaplaincy protocols are based on:
Correct answer: c. Source: Handzo G. The Process of Spiritual/Pastoral Care: A General Theory for Providing Spiritual/Pastoral Care Using Palliative Care as a Paradigm. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2.B.
2.B. Quality Indicator: All clients are offered the opportunity to have a discussion of religious/spiritual concerns. (Williams J, Meltzer D, et al. 2011.)
2.B. Metric: Percentage of clients who say they were offered a discussion of religious/spiritual concerns
2.B. Suggested Tool: Client survey
Process Indicator 2.B. Competencies
Process Indicator 2.B. What Do I Need to Know?
Test candidates should have knowledge of the theories and evidence that provide effective foundational policies, procedures and processes to establish and integrate chaplaincy care throughout a health care organization.
Reading: Do You Want to See the Chaplain? Ensuring a Patient’s Right to Pastoral Care and Spiritual Services. (Carlson, J. 2002.)
Process Indicator 2.B Sample Question
Spiritual screening should NOT include the question:
Correct answer: c. Source: Carlson, J. Do You Want to See the Chaplain? Ensuring a Patient’s Right to Pastoral Care and Spiritual Services. 2002. Vision 12(5).
Process Indicator 2.C.
2. C. Quality Indicator: An assessment of religious, spiritual and existential concerns using a structured instrument is developed and documented, and the information obtained from the assessment is integrated into the overall care plan. (The National Consensus Project for Quality Palliative Care. 2013; Puchalski C, Ferrell B, et.al. 2009.)
2.C. Metric: Percentage of clients assessed using established tools such as FICA (Puchalski C and Romer A. 2000) Hope (Anadarajah G and Hight E. 2001), 7X7 (Fitchett G. 1993), or Outcome Oriented (VandeCreek L and Lucas A. 2001) models with a spiritual care plan as part of the overall plan of care
2.C. Suggested Tool: Chart review
Process Indicator 2.C. Competencies
Process Indicator 2.C. What Do I Need to Know?
Test candidates should have not only a broad knowledge of chaplaincy practices as described in the competencies but also be able to demonstrate an understanding of the theory, evidence, and best practices that are central to every component of the provision of chaplaincy/spiritual care.
Reading: Improving the Quality of Spiritual Care as a Dimension of Palliative Care: the Report of the Consensus Conference. (Puchalski C, et al. 2009.)
Process Indicator 2.C. Sample Question
Which of the following is NOT true of spiritual screening?
Correct answer: d. Source: Puchalski C, et al. Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference. 2009. Journal of Palliative Medicine.
Process Indicator 2.D.
2.D. Quality Indicator: Spiritual, religious and cultural practices are facilitated for clients, the people important to them, and staff. (The National Consensus Project for Quality Palliative Care. 2013).
2.D. Metric: Referrals for spiritual practice
2.D. Suggested Tool: Referral logs, including disposition of referrals
Process Indicator 2.D. Competencies
Process Indicator 2.D. What Do I Need to Know?
Test candidates should have knowledge in cultural competence, inclusion, and vulnerable populations; the importance of diverse spiritual, religious, existential and cultural beliefs; assessment tools that explore, respond to, accommodate and document beliefs, values and practices; and the best practices to communicate their importance to other members of the interdisciplinary team.
Reading: Creating and Implementing a Spiritual/Pastoral Care Plan. Roberts S, et. al. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2.D Sample Question
The most important place for chaplains to include identified issues regarding religious, spiritual and existential practices is:
Correct answer: b. Source: Creating and Implementing a Spiritual/Pastoral Care Plan. Roberts S, et. al. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2.E.
2.E. Quality Indicator: Families are offered the opportunity to discuss spiritual issues during goals of care conferences. (Ernecoff N, Curlin F, et.al. 2015)
2.E. Metric: Percentage of meeting reports in which it is noted that families are given the opportunity to discuss spiritual issues
2.E. Suggested Tool: Chart audit
Process Indicator 2.E. Competencies
Process Indicator 2.E. What Do I Need to Know?
Test candidates should possess knowledge regarding key spiritual, religious, existential and cultural beliefs, values and practices at the end of life as well as methods by which to identify those components, find resources, provide appropriate interventions, and identify outcomes in collaboration with the patient and family to improve their decision making. In addition, the candidate should have a knowledge of medical ethics, the understanding of various ethical issues from diverse beliefs and values, how ethics committees work in an interdisciplinary manner, and best practices for participating effectively in ethical decision making, family conferences, and interdisciplinary plan of care meetings.
Reading: Health Care Professionals’ Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals-of-Care. (Ernecoff N, Curlin F, et.al. 2015).
Process Indicator 2.E Sample Question
Several studies have identified that goals of care conferences typically do not include discussion of religious or spiritual considerations. What major opportunity may health care professionals miss when these discussions are not held?
Correct answer: c. Source: Health Care Professionals’ Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals-of-Care. (Ernecoff N, Curlin F, et.al. 2015).
Process Indicator 2.F.
2.F. Quality Indicator: Spiritual care is provided in a culturally and linguistically appropriate manner. (The National Consensus Project for Quality Palliative Care. 2013) Clients’ values and beliefs are integrated into plans of care. (Joint Commission Resources. 2010)
2.F. Metric: 1) Percentage of clients who say that they were provided care in a culturally and linguistically appropriate manner, and 2) Percentage of documented plans of care that mention client beliefs and values
2.F. Suggested Tools: Client survey, chart audit
Process Indicator 2.F. Competencies
The competencies for this Indicator are the same as the competencies for Indicator 2.D.
Process Indicator 2.F. What Do I Need to Know?
Test candidates should have the knowledge of cultural and linguistically appropriate ways in which to engage persons in discussions of beliefs and values and how to incorporate them into plans of care, including the core knowledge of regulations from government, accrediting and professional organizations that advocate and educate about the importance of these issues.
Reading: Cultural Humility Versus a Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. (Tervalon, et al. 1998).
Process Indicator 2.F. Sample Question
Cultural humility differs from cultural competence in that:
Correct answer: b. Source: Cultural Humility Versus a Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. (Tervalon, et al. 1998).
Process Indicator 2.G.
2.G. Quality Indicator: End of life and bereavement care is provided as appropriate to the population served
2.G. Metric: Care plans for clients approaching end of life include document attention to end-of-life care. A documented plan for bereavement care after all deaths.
2.G. Suggested Tool: Chart audit
Process Indicator 2.G. Competencies
Process Indicator 2.G. What Do I Need to Know?
Test candidates should have the knowledge of current theories of grief and bereavement, including processes and interventions to provide appropriate care to those experiencing it within their own belief and value system.
Reading: Cultural Humility and Compassionate Presence at the End of Life. (Austerlic S. 2009).
Process Indicator 2.G Sample Question
Health care providers, including chaplains, must become knowledgeable of their patients' and families’ beliefs and values around end of life and bereavement and include them in the plan of care because principles, practices and procedures that are beneficial to one cultural group might be __________ to another.
Correct answer: a. Source: Cultural Humility and Compassionate Presence at the End of Life. (Austerlic S. 2009).
Outcomes are the desired difference that the chaplain’s contribution to the care of the patient/client, family and/or staff may help bring about. They are an observed and witnessed change in the person’s ability to cope and/or adapt; a measurable “turn-around” point or points. (VandeCreek and Lucas. 2001).
Outcome Indicator 3.A.
Quality Indicator: Clients’ spiritual needs are met. (Balboni, et.al. 2007)
Metric: Client-reported spiritual needs documented before and after spiritual care
Suggested Tools: Spiritual Needs Assessment Inventory for Patients (SNAP) (Sharma R, et al. 2012) and Spiritual Needs Questionnaire (SpNQ) (Bussing A, et al. 2010)
Outcome Indicator 3.B.
Quality Indicator: Spiritual care increases client satisfaction. (Marin et al. 2015)
Metric: Client-reported satisfaction documented before and after spiritual care
Outcome Indicator 3.C.
Quality Indicator: Spiritual care reduces spiritual distress. (Snowdon A, et al. 2013)
Metric: Client-reported spiritual distress documented before and after spiritual care
Suggested Tool: “Are you experiencing spiritual pain right now?” (Mako, C et al. 2006)
Outcome Indicator 3.D.
Quality Indicator: Spiritual interventions increase client’’ sense of peace. (Snowdon A, et al. 2013)
Metric: Client-reported peace measure documented before and after spiritual care
Outcome Indicator 3.E.
Quality Indicator: Spiritual care facilitates meaning-making for clients and family members. (Flannelly K. et al. 2005)
Metric: Client-reported measure of meaning documented before and after spiritual care
Outcome Indicator 3.F.
Quality Indicator: Spiritual care increases spiritual well-being. (Rabow M and Knish S. 2014)
Metric: Client-reported spiritual well-being documented before and after spiritual care
Suggested Tool: Facit-SP (Peterman A, et al. 2002)
The competencies listed below were determined to apply to all of the outcomes for Indicators 3.A through 3.F, and, therefore, are listed as a group rather than repeating the same list for each competency.
Outcomes Indictors 3.A.-3.F. What Do I Need to Know?
Test candidates should have knowledge of the definition of outcomes in chaplaincy care, best practices, and processes by which to consistently demonstrate them in their own practice.
Reading: Spiritual Pain Among Patients with Advanced Cancer in Palliative Care. (Mako C, et al. 2006)
Outcome Indicators 3.A.-3.F. Sample Question
Spiritual distress or “spiritual pain” typically falls into three main categories:
Correct answer: d. Source: Spiritual Pain Among Patients with Advanced Cancer in Palliative Care. (Mako C, et al. 2006)
Other books that will be helpful in building a test candidate’s knowledge base, and were drawn upon in the development of the standardized clinical knowledge test, include:
This list of references includes not only the articles and books referenced in the full Spiritual Care Association Learning Center course Preparation for Standardized Clinical Knowledge Test, it also includes additional resources that may be helpful to the test candidate. All references have links to where the reference can be found, either available as full text or requested on the website or the candidate’s medical library if available.