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Spiritual Care Association: Myth vs Fact

You’ve heard the myths about the Spiritual Care Association . . . but do you know the facts?

 

Myth

“SCA went rogue and refused to work within the established norms of the field.”

 

Fact

HealthCare Chaplaincy Network has worked for decades to bring evidence-based practice and research into health care chaplaincy - including providing major funding for the development of Common Competencies and the standards for specialty certification in palliative care and hospice, and the first major grant to fund chaplaincy research. The Spiritual Care Association was created reluctantly after HCCN became convinced by employers and others that the current chaplaincy training and certification processes were not producing reliably competent chaplains and thus endangering the survival of the field. Since the formation of SCA, nine of the thirteen chaplaincy certifying bodies have participated in regular round table discussions with SCA. Only APC, NACC and NAJC have refused to participate.

 

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The backstory concerning the genesis of the Spiritual Care Association is instructive here. HealthCare Chaplaincy Network (HCCN) has a long history of securing grants and leading on research and advocacy literature. Roughly ten years ago, HCCN secured a grant to gather worldwide leaders in Spiritual Care to develop and publish the first ever evidence-based Quality Indicators for Spiritual Care. The end of that process was an articulation of the next steps, now that this document had been created describing what quality spiritual care looks like, and how it might be measured. A second panel of experts convened and developed evidence-based Scope of Practice document, describing in concrete detail what chaplains need to do to produce quality spiritual care. The end of that process then, was a next step question once again. “What evidence do we have that the current chaplaincy education and certification process produces chaplains professionally competent to perform this Scope of Practice?”

At this time, the leadership of HCCN invited the leaders of the major chaplaincy certification and education groups to our office in New York City, where this was discussed. The consistent message received following that meeting was each organization was comfortable with the way they did things, and had little interest in partnering with HCCN in looking at potential structural and content changes.

At this point, HCCN had a decision to make. Do they stop advocating that the field become beholden to the published evidence, despite strong evidence? Or do they continue the process they had begun with the Quality Indicators and Scope of Practice, and focus on looking at what an evidence-based best practice educational and certification process look like? Deciding on the latter, HCCN then looked at both Graduate Medical Education and the certifying process and structures of chaplaincy-adjacent professions such as psychology, social work, and mental health professionals.

This led directly to the launch of the Spiritual Care Association, and the partnership with affiliate the Institute for Clinical Pastoral Training. The Spiritual Care Association’s approach to certification mirrors that of most healthcare and mental health professionals – with a content test and a recorded Simulated Patient Exam, where the applicant must demonstrate their competency and knowledge base in order to become certified. This new objective process is supported by the best evidence available, and is based on the competence of the applicant.

 

Myth

“All you need to do is take a test to be a BCC.”

 

Fact

Applicants must pass a rigorous spiritual care knowledge test, as well as an objectively scored simulated patient exam as a demonstration of clinical competence.

 

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An applicant to become board certified through the Spiritual Care Association must meet the following criteria in order to be eligible to take the core knowledge test and the simulated patient exam:

  • A minimum 30-hour Masters degree from a CHEA accredited (or international equivalent) institution in a content area relevant to chaplaincy
  • Within the Masters degree, must have one credit in at least three of the following areas:
    • Quality improvement
    • Research
    • Spiritual assessment, care planning, & documentation
    • Cultural competence/inclusion
    • End of life o Grief/bereavement
    • Ethics
    • Religious faith systems
    • Communication
    • Basic pathophysiology
  • Employee letter(s) verifying proof of working a minimum of 2,000 hours as a chaplain since completion of clinical training
  • Three letters of recommendation from (1) an administrator in the institution where the chaplain is currently employed or has been most recently employed; (2) a board certified chaplain or director of spiritual care at; and (3) a non-chaplain clinical professional colleague
  • Signing the Spiritual Care Associations Code of Ethics
  • A minimum of 800 hour (two units) of clinical training in spiritual/pastoral care, such as CPE

Note: SCA has this requirement of a minimum of two CPE units to take the simulated patient exam and the core knowledge test. It is this simulated patient exam and the core knowledge test that ultimately determines whether a person is qualified to work as a chaplain board certified through the SCA. The number of CPE units is not the decisive factor. An applicant must be able to demonstrate clinical competence as reflected by passing the simulated patient exam.

Once a person has completed the above, they are then eligible to take the core knowledge online test and the simulated patient exam. This test is robust, with an available bibliography of resources available to assist in preparation for taking it. The results of the test also highlight areas of opportunity for growth for the applicant, as it scores and assesses knowledge of specific topics relevant to professional chaplaincy. The SCA also has a wide ranging Online Learning Center (see here: https://spiritualcareassociation.org/education.html) with courses designed to provide sufficient resources for each section of the content test.

The online core knowledge test is also enormously helpful in guiding the candidate to work on areas where they are not as strong as others, and often the candidate is able to identify these areas of needed growth through sitting for the test.

 

Myth

“SCA is all about making money.”

 

Fact

SCA is the first multidisciplinary, international professional membership association for spiritual care providers that establishes evidence-based quality indicators, scope of practice, and a knowledge base for spiritual care. We provide competitive prices in our membership, certification process, and educational resources, as well as offer divisions such as the healthcare chaplain, first responder, nursing, hospice, military, and social work all coming in response to requests from the field. We have funded the development of an ever-growing offering of continuing education courses for spiritual care specialists and generalists. We are the only health care chaplaincy association with its own lobbyist in Washington, DC advocating for issues such as chaplain reimbursement.

 

More to the Story

HealthCare Chaplaincy Network and the Spiritual Care Association are nonprofit organization that relies on a combination of grants, membership dues, and fees for programs and services. In addition to providing world class evidence-based best practice research and subsequent resources for the field of chaplaincy worldwide, we also educate and certify chaplains. We invested significant resources to develop the evidence-based processes and structures, and also provide a professional lobbyist in Washington DC.

We provide many resources for free to the chaplaincy field, and our resources for which we do charge (Spiritual Care Grand Rounds webinars, an annual conference, online learning center, the Excellence in Spiritual Care Award, consulting services, etc.) are all priced below offerings from other organizations.

 

Myth

“SCA refuses to talk to the other chaplaincy associations.”

 

Fact

The Spiritual Care Association has regularly initiated conversations to find potential common ground with the Strategic Partners (NACC, APC, ACPE, NAJC). Each attempt has been functionally dismissed without engaging.

 

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However, there are some significant recent examples of collaboration between the SCA and the Strategic Partners. For example, in the recent publication of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care (available to download here: https://www.nationalcoalitionhpc.org/wp-content/uploads/2018/10/NCHPC-NCPGuidelines_4thED_web_FINAL.pdf), the content for Domain Five – the Spiritual, Religious, and Existential Aspects of Care, was co-authored by leaders from both the SCA and the APC.

 

Myth

“SCA has made certification easier to get.”

 

Fact

This myth confuses efficiency and efficacy. The SCA certification is much more efficient than the traditional process and is thus much easier to navigate and can be done in a much shorter time and at a lower cost. It places emphasis on demonstrating professional competence as opposed to evaluating the training the candidate has had and with whom. The goal of SCA is to confirm an applicant is clinically competent as a chaplain in order to be certified.

 

Myth

“SCA doesn’t care about formation, just credentialing.”

 

Fact

The SCA certification assumes that being able to adequately demonstrate the behaviors being scored in the simulated patient exam requires emotional intelligence and professional formation. In other words, it treats formation as a means to the end of high-quality spiritual care rather than an end in itself. As evidence of this formation, voice tone and non-verbal attentiveness are both scored. To set the overall tone, the preamble to the scoring sheet reads as follows:

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?

 

Myth

“SCA has made certification easier to get.”

 

Fact

This myth confuses efficiency and efficacy. The SCA certification is much more efficient than the traditional process and is thus much easier to navigate and can be done in a much shorter time and at a lower cost. It places emphasis on demonstrating professional competence as opposed to evaluating the training the candidate has had and with whom. The goal of SCA is to confirm an applicant is clinically competent as a chaplain in order to be certified.

 

More to the Story

The certification process of the SCA is competency-based, not credential based. The SCA uses evidence-based best practice in gauging when a person is sufficiently qualified to become board-certified as a chaplain. Seeking to be based on published evidence rather than subjective standards of readiness, the SCA developed the first of its kind Standardized Clinical Knowledge Test, that must be passed in order to become board-certified. This test reviews content from the international, interdisciplinary panel of experts who reviewed the published relevant literature, and authored both the Quality Indicators and the professional Scope of Practice, as well as essential resources supporting the learning objectives for the test.

The SCA has also developed and implemented the requirement to pass a simulated patient exam. A certification applicant signs into a video conferencing platform, and is given a referral, and then is live in a hospital room with an actor portraying a patient. This recorded visit is then evaluated using a standardized scorecard.

 

Myth

“The Institute for Clinical Pastoral Training (ICPT) is not recognized by the U.S. Department of Education, whereas the Association of Clinical Pastoral Education (ACPE) is.”

 

Fact

ACPE holds programmatic recognition by the DOE only to accredit its training centers and supervisors. The content, quality, and outcomes of CPE programs or ACPE policies and procedures regarding their programs, or ACPE supervisor performance, are not included in this recognition. There is no oversight of ACPE's clinical training by an accrediting agency.

ICPT holds institutional recognition by the DOE-designated ACCET as a program school. Every element of its clinical training including, but not limited to, its educational content, quality, and outcomes; supervisor teaching methods, requirements, and continuing education; student experience, and evaluations, and the entirety of ICPT's policies and procedures are included in the oversight by its accrediting agency.

 

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What is Department of Education Accreditation?

 The United States has no Federal ministry of education or other centralized authority exercising single national control over postsecondary educational institutions in this country. The U.S. Department of Education does not accredit educational institutions and/or programs. As a consequence, American educational institutions can vary widely in the character and quality of their programs. In order to insure a basic level of quality, the practice of accreditation arose in the United States as a means of conducting nongovernmental, peer evaluation of educational institutions and programs. The Department of Education provides oversight over the postsecondary accreditation system through its review of all federally-recognized accrediting agencies. Private educational associations of regional or national scope have adopted criteria reflecting the qualities of a sound educational program and have developed procedures for evaluating institutions or programs to determine whether or not they are operating at basic levels of quality.

 

How are ACPE’s and ICPT’s Accreditation different?

ICPT’s accreditation comes from the Accrediting Council for Continuing Education & Training (ACCET). ACCET is an Institutional Accrediting Agency whose scope is the accreditation throughout the United States of institutions of higher education that offer vocational and avocational training and continuing education programs that confer validated continuing education certificates or occupational associate degrees, including those programs offered via distance education. It is recognized by the U.S. Department of Education as a reliable authority concerning the quality of education or training offered by the institutions of higher education or higher education programs they accredit.

ICPT has been awarded a three-year Institutional Accreditation.

Institutional accreditation is the process that evaluates and attests to the institution’s compliance with the standards of the accrediting agency in all areas of the organization, including goals and planning, management, finances, curricula, instructional staff and delivery, admissions and student services, and evaluation. Institutional accreditation applies to an entire institution, indicating that each of an institution’s parts is contributing to the achievement of the institution’s objectives, although not necessarily all at the same level of quality. Institutions report on their organization and all aspects of its programs annually to ensure that students receive a quality education and get what they pay for. Attending an accredited institution is often a requirement for employment and can be helpful later on if a student wants to transfer academic credits to another institution. ICPT Finally, ICPT, with institutional accreditation, has the ability, and hopes to in the future, offer Title IV programs for its students.

While ACPE was found to be out of compliance in 2012, ACPE currently does have recognition from The National Advisory Committee on Institutional Quality and Integrity (NACIQI) through 2022, which provides recommendations regarding accrediting agencies, both institutional and programmatic. ACPE is the only programmatic agency certifying CPE centers and supervisors recognized by NACIQI. It is a program outside NACIQI’s regular accreditation endeavors.

ACPE is recognized as a Programmatic Accrediting Agency. These are agencies that accredit specific educational programs that prepare students for entry into a profession, occupation, or vocation. Some programmatic accreditors are recognized for the accreditation of freestanding, single purpose institutions in addition to the accreditation of specialized programs at larger institutions. ACPE’s programmatic scope of Recognition is the accreditation of both clinical pastoral education (CPE) centers and Supervisory CPE programs located within the United States and territories. As a result, most of ACPE’s training sites are not “recognized institutions” by their state departments of education nor the U.S. Department of Education. They are simply internal training divisions within corporations (e.g. hospitals, prisons, hospice centers, churches).

ACPE does not hold accreditation for the content of its education programs or the quality of its outcomes. While ICPT’s Institutional Accreditation recognizes it as a school and education provider, ACPE’s programmatic accreditation only allows it to accredit individual centers and certify supervisors. ACPE is not recognized as an education provider or school.

Finally, ACPE’s programmatic accreditation does not include Title IV, meaning it is not eligible to offer those programs, such as Pell Grants and student loan programs.

 

What is the difference between ICPT’s and ACPE’s Clinical Pastoral Education (CPE)?

ICPT provides quality, uniform Clinical Pastoral Education. Our training, including both the traditional components of the CPE process and the standardized knowledge courses, has been reviewed an evaluated by subject matter specialists trained and approved as Commission Representatives with a US Department of Education Recognized Institutional Accreditor. Students know exactly what topics they will be learning with CPE objectives as well as knowledge learning outcomes, both of which are incorporated into a developmental approach to learning. Administrators and employers can receive from students an itemized, complete transcript of competencies that the student has mastered and have knowledge of the skills they are hiring.

ACPE does not have a consistent or standardized method of assuring that students meet the objectives and outcomes for its CPE students or competencies for its Certified Educators. As a result, it cannot identify for potential students consistent topics they will learn about nor can it demonstrate to potential employers that students have completed the knowledge and skills necessary to function professionally. Because ACPE is its own programmatic accreditor for its programs, there is no independent review of its training by subject matter specialists trained and approved as Commission Representatives with a U.S. Department of Education Recognized Institutional Accreditor.

 

Myth

“SCA’s CPE is not recognized by anyone.”

 

Fact

SCA does not do CPE. It does, however, partner with the ICPT, (which is accredited by DOE-designated ACCET), who does provide CPE. ICPT’s CPE is recognized by many of the 13 chaplaincy certifying bodies in the United States.

 

Myth

“SCA is less reputable both as a certification and as an organization.”

 

Fact

SCA is new and presents a new paradigm for certification. The entire ecosystem of educational offerings, certification processes and structures, and resources are evidence-based. The SCA is beholden to the evidence and will continue to evolve and grow as the body of relevant evidence does. All evidence to this point indicates that such a new paradigm and system for chaplaincy resources and certification is not only reputable within the field, but also viewed favorably by non-chaplain clinicians and administrators. No one knows how many chaplaincy employers across settings accept SCA certification. We do know that a rapidly growing number of employers do accept it as they come to understand the reliable quality of SCA certified chaplains.

 

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The reputation of an organization comes through the people connected to it, in this case, those whom the SCA certifies as competent chaplains. We are confident that the quality of their care, the breadth of their knowledge base, and the scope of their practice will continue to convince those with whom they work of the reliability, effectiveness, and competence of the chaplains we have certified.