Office of the Bishop Suffragan for Chaplaincies Health Notes   April 2005 Taming the CCAPS Accreditation Monster Written by Chaplain Michael Pollitt Chief , Chaplain Service - Coatesville VA Medical Center As Director of the United States Department of Veteran’s Affairs National Chaplain Center, I am fully supportive of CCAPS Accreditation of VA Healthcare Facilities. VA presently has two CCAPS accredited facilities with one or two others preparing to enter the process. Chaplains at the accredited facilities and those preparing for accreditation both report the same significant growth experiences and learning outcomes. Those completing the process unanimously report that the CCAPS accreditation experience is one that is well worth the effort and expense and will be of value for years to come for the chaplains, the department, and the facility. - Chaplain Hugh Maddry John Greenleaf Whittier penned the famous line, “For of all sad words of tongue or pen, The saddest are these: ‘It might have been!” Sad indeed are the many great VA chaplaincies around the country that have never gotten the recognition they deserve. For a multitude of reasons these programs have lived in an obscurity that need not be. The Coatesville Veterans Affairs Medical Center Chaplaincy has just gone through a successful CCAPS (COMISS Commission for the Accreditation of Pastoral Services) accreditation process and I’m here to say that accreditation is well within the grasp of any VA medical center. We had been considering seeking accreditation for some time but the magnitude of the process appeared so daunting that the decision to pursue was quite difficult. We did decide to go forward, though, because we believed that we were a very good chaplaincy and that the CCAPS accreditation would only make us better. It is because of CCAPS and its standards of professional chaplaincy that we came to terms with what we are able to accomplish as professional healthcare chaplains. What follows is a report of how this was accomplished and of the many benefits derived from accreditation. The process itself is divided into two major stages: Assessment and Evaluation, and Standards. After having been granted accreditation there is a third stage, periodic accreditation review. In the first stage the medical center chaplain service assesses and evaluates itself on the eleven criteria established by COMISS. In the section on Standards the chaplain service details how it has already met the COMISS Standards in its day-to-day operations. One major advantage that VA chaplain services have over civilian chaplaincies that it already adheres to established standards and practices found within the old M-2, Part II (Clinical Affairs: Chaplain Service) and its replacement, the soon-to-be-issued Handbook on Spiritual and Pastoral Care Procedures. Thus, all of what is expected by CCAPS already is expected at least some degree of every VA chaplain service. The key is getting started and having a systemic approach. That approach starts at the top. One must remember throughout the process that because accreditation belongs to the medical center, the medical center director is an active member of the CCAPS process and all 2 CCAPS Accreditation correspondence is directed to him or her, just as with JCAHO. The leadership of the medical center has to consent to and be willing to finance the accreditation process. Assistance from the Chief of Staff for the survey of all doctors as well as the head of nursing for the survey of all nurses is the next thing that is needed. CCAPS survey forms should be sent to all attending physicians and nurses. In our case, these forms were sent out in November and December 2003, that is, approximately nine months before the expected site visit. Most of the replies came back by the end of December 2003. There was a return rate of 51% (N 19) for attending physicians, and 59% (N 53) for nurses. The survey results for attending physicians and nursing staff were compiled from sixteen and nineteen questions respectively, using the responses of always, usually, sometimes, and never. This information was broken down into raw data, with attached comments, and also a series of bar graphs for each of the questions. This information was added to the other ten elements of the Assessment and Evaluation section of the Report which looked at the goals and outcomes/objectives for chaplain service for the last five years, the budget for the previous five years, position descriptions and curricula vitae for all current employees, policies and procedures for chaplain service, description of the medical center as a whole along with the mission statement, history of chaplaincy, including any previous accreditation, the organizational chart of the facility and of chaplaincy, chaplaincy’s scope of service and scope of practice, and of its ongoing quality improvement program. All of this was compiled in a tabbed report and submitted to CCAPS before site visitation for comments and changes. The final version was required to be in the hands of the three surveyors at least three before the visit. As a result of these surveys we were able to see our strengths and weaknesses from a new perspective. Both physicians and nurses viewed the chaplain staff as an integral and active part of the unit treatment teams whose opinions were highly valued. Both groups noted that chaplains responded quickly and communicated well with the staff. Both groups considered the pastoral counseling, the sacramental ministry, and the ethical resources that chaplains provide to be efficient, abundant, and helpful. Nurses noted in particular that the role of the chaplain when death occurs, both in regard to the patient and to the family, was satisfactorily addressed. From the perspective of our fellow healthcare team members, these were among our greatest strengths. Having thus been identified, we knew our next task was not to reinvent the way we handled these matters, but instead to continue to build on these strengths. This gave us freedom to pursue areas where some changes could be beneficial. For instance, there is chaplain coverage of all patients round the clock, with no exception; chaplains are available not just for death services but for all services, at all times. A problem, however, was identified as a result of these surveys, when they revealed that not all the nursing staff was aware of this chaplain availability. The problem was one of communication, and one that we easily addressed. Thus, by identifying our strengths and weaknesses, as these examples show, we are better able to allocate our time and energy to areas that need it. In short, we become a more efficient and effective chaplain service. The second stage on Standards comprises of a series of questions designed to see if and how the program measures up to CCAPS’ Standards. A narrative answer is given to each question from areas of budget, staffing, facilities, medical center professional staff, the director, other pastoral services providers, support staff, organizational service, outreach programs, 3 CCAPS Accreditation community relations and education, and documentation. Areas of the Standards’ section that requires further information make up the appendix portion of the report. In our instance, it included twelve appendixes: Spiritual Assessments, Patients’ Rights, Budget, Patient Coverage, Staffing Guide, All Faith Chapel, Job Description, Code of Ethics, Performance Appraisal, Interdisciplinary Teams, Education Projects, and Chaplain Staff Meetings. While the assemblage of these appendixes is timeconsuming, it is not overwhelming and with proper foresight and budgeting of time can be easily completed. Lessons Learned, Benefits Gained The process itself, regardless of outcome, is a learning experience and an opportunity for selfreflection. As a result of the CCAPS process the Chief Chaplain, as well as the entire chaplain staff, acquire an unparallel knowledge of its chaplaincy. This internal examination/audit explores your program like no other. Everything about your chaplaincy, from the very important to the minute, becomes knowledge on the tip of you fingers. The process gives you first hand knowledge of your chaplaincy budget history and goals, a thorough knowledge of the skills and credentials of staff members, a first hand knowledge of all pastoral services policies and procedures, how doctors and nurses truly see the role and importance of chaplaincy, and a much deeper understanding of the history of your chaplaincy. It is very clear that the process itself strengthens the chaplaincy through the increased communication among the chaplain service, the medical center, and COMISS and through a spirit of cooperation needed among each entity to complete the team effort. It forces the service to hold up a mirror to its programs. It requires reflection upon its mission statement and evaluation as to how it lives up to that statement. It also identifies weaknesses for future program improvement. It makes one aware of any gaps or limitations in coverage, so that this can be addressed in future personnel searches. The final report serves as an instant desk reference ready to clarify any aspect of the chaplaincy concerning the service; all sorts of data are at one’s fingertips. It energizes the whole service to overcome any weaknesses identified and to capitalize on its strengths. Personally, we at Coatesville VA Medical Center have benefited greatly from the accreditation process. It has been a challenging and thoroughly enriching experience, and we are looking forward to the final stage, periodic accreditation review. The Spiritual and Pastoral Care Research Information Newsletter is produced and distributed by e-mail to VA Chaplains by the National VA Chaplain Center, Chaplain Hugh A. Maddry, Director 301/111C Hampton, VA 23667 757-728-3180 A Deacon's View from Inside "815" by Dn. Michael Stewart, St. John's, Mason City, Iowa Since September 11th, 2001, I have spent eighteen months at the Episcopal Church Center in New York City, commonly called "815" because its address is 815 Second Avenue. I had visited there a number of times for meetings of the executive committee of the Assembly of Episcopal Healthcare Chaplains (AEHC) with the Bishop of the Armed Services, Healthcare and Prison Ministries; early this year this office was renamed the Bishop for Chaplaincies. The Bishop Suffragan currently serving this post is the Rt. Rev. George Packard. My first tour with this ministry was as a volunteer beginning a week after 9/11. At 815 I augmented Bishop Packard's staff, helped schedule two clergy at St. Paul's Chapel 24/7, and was part of a team of chaplains who presented 18 four-hour grief/crisis intervention/self-care classes in the dioceses directly affected (greated New York, greater Washington, DC, and Pennsylvania) by the events immediately following 9/11. The work of deacons at ground zero has been well documented in prior issues of Diakoneo. In these two months I saw and learned much about clergy, volunteers, bureaucracy, New York City, humankind, dedication, territoriality, fear, love, and about 815. We had a priest who wanted to be paid to come to St. Paul's; we had a priest who would only come if the priest could bring a reporter. We found as a general rule that clergy whose only experience was in a parish were totally overcome and inadequately prepared to deal with the situation. We found generally that clergy and laity performed best in this terrible situation who were trained in Critical Incident Stress Managment (CISM), closely followed by clergy and laity who had some experience as a chaplain in addition to at least one unit of CPE. One of my tasks was to assist with the evaluation of how well the Episcopal Church including the Episcopal Church Center, and the Diocese of New York in particular, and the closest Episcopal entities — St. Paul's Chapel, Trinity Church and Seamen's Institute — had, in fact, responded to 9/11, the first attack on the continental United States since the War of 1812. We concluded that all had responded as well as could have been expected given the circumstances. But there were lessons to be learned and prior planning is the key to any crisis/disaster/terrorism event. Unfortunately, now we have had an experience from which to learn. One vignette will suffice. A priest colleague who inderstands diaconal ministry had taken a visiting priest with her for a night shift at St. Paul's Chapel. Toward the end of the shift the visiting priest commented that it was too bad that they could not have done more “sacramental things.” To which my colleague responded, “What do you think serving food, distributing Visine and boots to rescue workers is?” As a result of all of this effort, Bishop Packard's office professionally produced 10,000 copies of a CD entitled “What To Do Next When a Disaster Strikes." As editor of this CD, I worked to ensure that it would be user friendly, an excellent resource, and a helpful tool to get your parish ready for a disaster of any kind. It also has real time links to some wonderful websites which help keep the resources current. A copy was mailed to every congregation around Easter 2003. A copy may be obtained by e-mail or calling Andrew Gary at agary@episcopalchurch.org ot 800-334-7626 extension 6067. I returned home for a two-week break and to attend the Packers/Vikings game and then returned to New York to complete my two-month tour. In late May 2002, Bishop Packard asked if I would consider a second tour as the Interim Director for Healthcare Ministries. I agreed to do so part-time until the end of the year. Thus I began cmmuting to New York once or twice a month for a week as a paid staff member, and I worked at home during the remaining weeks. Bishop Packard's office has three directors:one for Healthcare Ministries including Veteran Administration (VA) Chaplains, one for Prison Ministries, and one for Military Ministries. In the aftermath of 9/11 we discovered Episcopal chaplains previously unknown to us, who served in various “civil/street” chaplain capacities, e.g., FBI, ATF, disaster mortuary operational response team, police, fire, EMT, etc. Most of these discoveries occurred at Ground Zero through chance meetings with military and healthcare chaplains and other volunteers. We realized that we needed to integrate these chaplains into our office before the next disaster. As the national church came to realize after 9/11, the Episcopal tradition of only sending money for disaster relief is not enough. The Church needed to provide additional resources, as our fellow brothers and sisters in Christ do. After all God sent his Son in the flesh to give us relief from sin. Changing this paradigm was not easily or quickly done. The national church had no mechanism to implement this shift. With no additional resources provided, the legitimate concern arose in Bishop Packard's office as to whether we were also becoming the office for “disasters,” since most thoughtful people presume that sooner or later there will be another terrorist attack against our homeland. Let me note that Episcopal Relief and Development (ERD) did provide some financial resources to cover the immediate, direct expenses of the church at Ground Zero. The first step in becoming more pro-active in disaster preparedness was to change the name of the office to reflect more accurately what role we were being asked to fulfill. No existing office at the Episcopal Church Center was even remotely equipped to respond to a disaster, or even disaster planning except ERD, and their response was chiefly financial. In fact, Bishop Packard's office is canonically charged to directly recruit, support and endorse federal chaplains — active duty military chaplains including the civil air patrol, full time federal VA chaplains, and federal prison chaplains. Several years ago the healthcare professional certifying bodies required each faith tradition with adjudicatory jurisdictions to endorse their candidates through a central office. This process of indirect support from Bishop Packard's office to non-federal chaplains, along with ongoing support and education of diocesan bishops and both lay and ordained chaplains, has continued. Since in all cases of endorsement the first step is a recommendation from the applicant's diocesan bishop, the office does facilitate communication and education between the parties about “non-parochial” clergy and laity in institutional/specialized ministry. In fact, at General Convention the Chaplaincies booth handed out buttons which said: “Non-Parochial — Let's retire the word.” The next step was to form a National Church Disaster Response Team for the next terrorist attacks. I chair this newly formed team. As soon as the target area is both safe and accessible, the team (having gained the concurrence of the local diocesan bishop) is to physically assess what local congregations can do, what the diocese can do, and what the national church can do. To illustrate the process, members of the team consulted with the Diocese of Utah before the last winter Olympics. Last January, based on the experience from 9/11, the Presiding Bishop signed a Memorandum of Understanding with the International Critical Incident Stress Foundation to facilitate cooperation bewtween the two organizations to help prepare for disaster preparedness through training. There is still much more to do. Our goal is eventually to have a “disaster coordinator” in each province who can then recruit diocesan representatives in the diocese. The most urgent need is for advance training and planning. While some dioceses have areas more vulnerable and subject to a terrorist attack, every diocese is potentailly subject to some form of natural disaster or major traumatic event, such as a fire. Unfortunately, as time has passed since 9/11, and with most of the country geographically far distant from the first atacks, interest in preparedness has waned as attention has become focused on other church issues. Let us return to my duties in New York. Bishop Packard (in the absence of a diocesan bishop in Iowa) ordained my wife, Barb to the transitional diaconate in the Chapel of Christ the Lord at 815 on October 16, 2002. She is a long time hospital chaplain and a former Methodist pastor. Not many ordinations occur at 815. After my response to 9/11 and its direct ramifications, my duties focused on a follow-up conference on healthcare. At General Convention 2000 Resolution AO79 was passed, calling for a number of healthcare related activities. The primary focus of this resolution was a call for universal access to healthcare. In July 2001 at the College of Preachers, Bishop Packard convened an invitation-only conference of 40 people, representing many disciplines, to identify the major challenges involving healthcare. My job was to plan and execute a follow-up conference. Part of Resolution AO79 called for coordination among several Episcopal organizations committed to better healthcare. With the help of a superb steering committee and a consultant, we gathered in April 2003. This diverse group of eighty Episcopal healthcare professionals — bishops, laity, and physicians-priests, successful providers of solutions to access to healthcare, nurse, acamedicians, and many other healthcare professionals gathered in Washington to learn, to share and to lobby. Members of Congress, lobbyists, acamedicians, and healthcare professionals brought us up to date on the current state of healthcare in America. Using the nursing model we sponsored a “best practice” poster and panel presentation on current successful examples of providing healthcare. Through the Episcopal office of governmental relations we arrranged 100 confirmed appointments with Members of Congress — a phenomenal number — with generally positive results. The follow-up is another conference in 2005, hopefully hosted by the National Episcpoal Health Ministries. Obviously, Bishop Packard's office is not set up to do progammatic work but, like the aftermath of 9/11, Resolution AO709 fell by default to this office. The Conference, by all measures, was a tremendous success even though it met just after the Iraq War had commenced. Having agreed to extend my contract through General Convention and with having expended much of my consultant contract funding with the organizing and execution of the conference, my hours and duties were reduced. My service culminated with General Convention 2003, where I was to floor manage Resolution A124 which sought to re-establish the Standing Committee on Health. Passage of this resolution was imperative, given the fact that no office at 815 has responsibility for any aspect of healthcare, except for healthcare chaplains themselves. That resolution did eventually pass but, unfortunately, without funding. I close this summary of my experiences at 815 and my subsequent duties with my observations as the only deacon “in residence” at 815. Deacons are not used at the daily masses at 815. I have been asked to read the gospel, only to be pre-empted. I did wear my collar at 815 to “blend in.” I learned much about the Church Center and made many friends, some of whom did not know I was a deacon. Overall, I feel very positive about the experience. I certainly am much wiser and more knowledgeable. Politics abound everywhere as do varying degrees of expertise and competency. I learned to love New York, and at times, miss it very much. What I enjoyed most about my time in New York was that I had the opportunity to evangelize for chaplaincy which after all, is my greatest love and my greatest passion. I worshipped at St. Bartholomew's and fell in love with it, as did my wife. I have concluded that deacons are measured and judged by clergy and laity by their minsitry and their competency. At the end of my eighteen months I still believe that deacons are expected to be “better,” to do more, and to jump over a “higher bar” than others. A servant ministry has a high “price!” Is that not the way it should be? Michael O. Stewarrt, PhD is a deacon at St. John's Church in Mason City, Iowa, and is Treasurer of the AEHC. He has been ordained 11 years, and served in three dioceses under five bishops. He is a retired USAR Medical Serivce Corps Colonel; a retired college and university chief financial officer and Diocesan treasurer; and a retired full-time hospital chaplain at a medical college, where he served primarily in the trauma/emergency room, and a retired associate chaplain in the Associatoin of Professional Chaplains. He is currently serving and has served as a CISM team leader and member for five years.