The NACC is now offering a new certification specialty in palliative care and hospice. This article will provide a background and rationale on its development, an overview of the process of certification, and a commentary on the standards.
Background and rationale
The NACC Board of Directors, at its October 2012 Board meeting, devoted time to prioritize under each goal of the NACC Strategic Plan 2012-17 a primary objective for 2012-2013. Under Goal Three, To Enhance Advocacy Efforts with Strategic Partners, it identified the objective: Continue dialogue with other key professional organizations integral to advancing the profession of chaplaincy. The Board charged a Strategic Goal Three work team with coming to the April 2013 NACC Board meeting with a recommendation regarding a palliative care certification specialty. Either the NACC should or should not offer one. The key strategic partner in this study was the Supportive Care Coalition. Mary Lou O’Gorman, NACC Board chair-elect was the Board liaison, and Gary Weisbrich chaired the Goal Three work team. They explored the rationale and feasibility for a palliative care specialty certification.
As the work team explored this issue, the rationale for offering this specialty became clearer. This rationale was based on three realities. First of all, within Catholic healthcare (70% of our members identify themselves with Catholic healthcare organizations), palliative care is viewed as a hallmark of Catholic healthcare, intrinsic to its healing mission. Palliative care in Catholic healthcare is grounded and guided by the Ethical and Religious Directives for Catholic Health Care Services. Developing a certification specialty in palliative care that is rooted in our Catholic mission and in partnership with the Supportive Care Coalition that represents many Catholic healthcare systems was a logical step. Secondly, as this question was being explored, the National Consensus Project (NCP) (www.nationalconsensusproject.org) published in early spring 2013 its Clinical Practice Guidelines for Quality Palliative Care 3rd edition 2013. Its Domaine Five on Spiritual Care was vastly expanded and improved from its earlier editions. While considering the Association of Professional Chaplains (APC) Hospice and Palliative Care competencies as a basis for developing its own, the NACC deemed it valuable to use these NCP revised clinical guidelines as the framework for developing standards for the NACC palliative care and hospice specialty certification. Thirdly, many of our board certified members work in palliative and hospice care, and certification and credentialing in this special ministry is called for more and more. With APC requiring board certification with APC in order to apply for its hospice and palliative care specialty, it was important that our NACC members also have this specialty certification for their ministry.
At its April 2013 meeting, the NACC Board of Directors approved the recommendation of the Goal Three work team to proceed with developing and offering a certification specialty in palliative care. In early May 2013, a task force composed of members of the NACC Certification and Standards Commissions, as well as other select NACC members, began working on both the process and standards for this specialty.
As the process and standards were developed, the members viewed palliative and end-of-life care to be overarching care service under which hospice care is viewed as a specialized palliative care for terminally ill patients who may have only months to live. Thus the process and standards use Palliative Care and Hospice as the title of specialty certification, palliative care/hospice when referring to the chaplain or the care team, and palliative and end-of-life care when referring to the services provided.
An overview of the process
As the Work Team identified the prerequisites for an applicant, the applicant needed to be board certified with the NACC, this person’s prior experience in palliative or hospice care would be required in clinical hours, as is done in nursing, and not by a number of years. This allows for someone to have worked more intensely over a briefer period to qualify for applying for the certification. As an applicant needs to show “extensive education in the field,” what type of education is not specified. Thus, someone might have a more formal training, such as the certificate program of HealthCare Chaplaincy, or can evidence a variety of education, such as workshops, reading, and other training methods. It is also important that the applicant evidence some form of supervision of consultation as way of growing personally and professionally in the field.
The Work Team spent significant time discussing/developing the applicant process. Highlights of the process include letters of recommendation, as they give people with whom one worked in palliative care or hospice an opportunity to affirm and endorse one’s work in the field. Also, the applicant will find the expectation of a written narrative that includes how one entered into this ministry, one’s spirituality and theological underpinnings for the ministry, examples of one’s educational role, and a description on how one meets the competencies for palliative care or hospice. One will also need to prepare a case study that includes at least five (5) successive palliative and end-of-life care interventions/consultations with accompanying reflection and medical record charting notes.
The Work Team decided early in their deliberations that an in-person interview, rather than a phone interview, was important, albeit a significant investment for both the applicant and the NACC. As in the case of one’s initial certification process, the interview team would be comprised of three individuals: a minimum of two (2) board certified chaplains with palliative care or hospice experience and/or palliative care and hospice certification, and one palliative care/hospice interdisciplinary team member. The other elements of the process follow closely NACC’s certification interview process. The interview team will make a recommendation to the NACC Certification Commission. The interviews will normally take place during the regular NACC scheduled certification interviews, first weekends of October and May.
It was also decided that the renewal process of one’s specialty certification will coincide with one’s normal five-year renewal of certification, with the requirement that fifteen (15) of one’s fifty (50) continuing education hours (CEH’s) must relate to palliative and end-of- life care, beginning in the year that specialty certification was received. The peer reviewer must be an active or retired certified chaplain or CPE supervisor (as applicable) with palliative care and hospice specialty certification or experience with whom one does not share a reporting relationship.
Commentary on the Standards NACC Standards for Specialty Certification in Palliative Care and Hospice
As noted above the NACC Standards for Specialty Certification in Palliative Care and Hospice (SCPCH) are presented in the context of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care (3rd Edition), which includes a definition that characterizes palliative care in the United States, also used by the U.S. Department of Health and Human Services (HHS) Centers for Medicare/Medicaid Services (CMS) and the National Quality Forum (NQF). It was important that the NACC SCPCH reflect the content of these clinical practice guidelines with their distinguishing features of interdisciplinary team coordination, collaboration and communication among patients, families, and care providers, services available either concurrently with or independent of curative or life-prolonging care, and respecting and supporting the patient and family hopes for peace and dignity throughout the course of illness, during the dying process, and after death.
As APC’s competencies for hospice and palliative care, the NACC’s SCPCH structure follows the fourfold division of the NACC (and Common Standards) certification standards: theory of pastoral care, identity and conduct, pastoral, and professional. However, one will see emphasized in diverse ways the interdisciplinary team, proficiency in communication and facilitation, application of the Ethical and Religious Directives for Catholic Healthcare (ERD’s), and learning, articulating, honoring the patient’s and family’s dignity and desires. So, for instance, among the theoretical competencies one finds an emphasis on the chaplain’s ability to articulate and/or facilitate discussions with the interdisciplinary care team on a theology of suffering, loss, and pain, as well as to understand and integrate the consensus definition of spirituality into palliative and end-of-life care. The chaplain also needs to demonstrate the knowledge and skills in addressing ethical issues that arise in palliative and end-of-life care, especially in applying the Ethical and Religious Directives for Catholic Healthcare Services (ERD’s).
Among identity and conduct competencies, the chaplain is expected to function within the interdisciplinary team in a way that models and facilitates communication that honors human dignity and highlights the relevance of the spiritual, religious, and existential dimensions of care. “Model” is frequently used in this section as it emphasizes that the chaplain not only does his or her own self-awareness, self-care, and self-reflection, but can confidently help provide education for and facilitate this reflective process among the palliative and end-of-life interdisciplinary team members.
Also among the pastoral competencies, one will see again the verbs “lead,” “teach,” “assist,” “mentor,” and “model,” in referring to the chaplain’s roles with the interdisciplinary care team, in patient/family conferences, support groups, and bereavement support. The pastoral competencies also include promoting the inclusion of spiritual/religious symbols sensitive to patient/family beliefs, leading and facilitating rituals, and ensuring access to religious leaders as needed.
Finally, the professional competencies emphasize the chaplain’s working knowledge of key principles and research-based best practices in chaplaincy palliative and end-of-life care, and of community resources for palliative and end-of-life care. They also include the chaplain’s ability to integrate chaplaincy care into the organization through diverse and appropriate means and measures.
How are we implementing this certification specialty?
The Palliative Care and Hospice Implementation Team will initially select six NACC members who have the prerequisite experience in either palliative care or hospice to participate in the initial certification process. These six members with select interviewers meet in Milwaukee to go through the initial round of interviews, in order to help us also to refine the interview process, as well as to become prepared to be future interviewers for this certification specialty. This will occur during the first half of 2014.
As mentioned above, future interviews for this certification specialty will coincide with NACC normal certification interview times and places, the first weekends of October and May. Therefore, deadlines for materials for application for the certification specialty will also be Feb. 15 and Sept. 15 of each year. We realize the Feb. 15, 2014, deadline will likely be met by few applicants.
Please watch for further information in NACC Now and other NACC communications.
Please join us in praying for the success of this much needed certification specialty.
David A. Lichter, D.Min.
