Purposes of the Ideal Intervention Project (IIP)
The overall purpose of the IIP is to improve the quality of spiritual care (SC). Specific uses of the IIP/SC knowledge base include:
- Provision of insights from IIP/SC knowledge base samples to SC students, practitioners and educators ministering in similar situations
- Consolidation of student, practitioner and educator learning through the discipline of writing brief IIP papers
- Submission of those papers for editing into the IIP/SC knowledge base (writers must approve edits; anonymity is assured)
- Education of decision-makers
- Documentation of competencies for certification
- Justification of Medicare reimbursement
- Assessment of effectiveness of samples' replications resulting in the identification of evidence based SC best practices
Background
The IIP was conceived by Henry G. Heffernan SJ, an NIH staff chaplain. He adapted the IIP paper for CPE students from a cognitive therapy template to consolidate learnings from verbatim presentations to peers and to allow improvement in the quality of SC by amassing those learnings to apply to specific future situations. The IIP was introduced into CPE curricula and piloted with several intern groups and one resident group in the East Central ACPE Region 2006-2008. Based on student and educator critiques, a revised protocol was introduced. Minor adjustments to the protocol have been made since that time. Today, IIP papers are also being solicited from clinical, correctional and military chaplains, parish clergy, seminarians, pastoral counselors, academics, and spirit-oriented members of other disciplines for inclusion in the IIP/SC knowledge base.
The Knowledge Base of Professions
A defining characteristic of the professions is the organized way in which the profession accumulates relevant knowledge, organizes that knowledge in theoretical structures, validates this knowledge through systematic processes, and communicates this knowledge to members of the profession.[1] Prior to the IIP, the SC knowledge base amassed over some 80 years has consisted primarily of top-down, deductive textbooks, association-specific manuals, and loosely related materials.
The IIP/SC Knowledge Base
The IIP/SC Knowledge Base is the first known collection of actual SC ministry samples--including learnings gained--organized in 23 bottom-up, inductively arrived-at categories. This knowledge base is freely available to all and is hosted by the ACPE Research Network, John Ehman, coordinator, with 186 samples to date.
The IIP Research Design
Steps Underway:
- The IIP consolidates SC student, practitioner and educator learnings by the disciplined writing of IIP papers
- These papers are submitted to the IIP/SC knowledge base editor, John Gleason, at mariejohn50@att.net for editing
- After writer approval of the edits, the IIP papers are entered anonymously as samples into the freely accessible online IIP/SC knowledge base at http://www.acperesearch.net
Steps Awaiting Action:
- A brief effectiveness questionnaire is created
- Institutional approval is obtained foruse of the effectiveness questionnaire
- The provider of an SC intervention to be assessed by use of the effectiveness questionnaire writes an IIP paper and submits it to the IIP/SC knowledge base editor
- A third party administers the effectiveness questionnaire to the recipient of that intervention
- Interventions designated as effective are replicated and evaluated for effectiveness
- After sufficient successful replications, effective interventions are designated as evidence based SC best practices
Survival of Professional SC in the Emerging Pay-for-Results Paradigm
In addition to fulfilling the IIP's overall purpose of improving the quality of SC, successful accomplishment of the IIP research design will be essential to the survival of professional SC in the U.S., given the emerging pay-for-results paradigm that has its basis in "validating...knowledge...through systematic processes."[2] Data supporting this forecast includes the following.
- U.S. health care costs continue to spiral upward. The Medicare Office of the Actuary projects that such costs will reach $4.6 trillion in 2020, accounting for about $1 of every $5 in the economy.[3]
- The Affordable Care Act is being implemented. In 2011 the Independent Payment Advisory Board is recommending ways to improve health outcomes for patients. In 2012 programs and controls that improve quality outcomes for patients and encourage more accountability among health care professionals will be implemented. In 2015 Medicare will begin rewarding the quality of care rather than the amount of services.[4]
- In one of the U.S. military's branches its chaplaincy has been ordered to justify its existence. Another branch's chaplain corps is attempting to establish the costs of specific SC interventions and services.[5]
- Pay-for-performance systems are on the increase. 75% of all U.S. companies connect at least part of an employee's pay to measures of performance. In health care over 100 private and federal pilot programs are underway.[6] In education several states have committed to using value-added analysis in teacher evaluation in order to secure financing from the Obama administration's Race to the Top program.[7]
- At least one other country’s health care chaplaincy is moving toward pay-for-results. In Scotland a 2008 study found that a secure future for chaplaincy will be linked to creating a better knowledge base about practice. Chaplains are being asked to show that what they do results in desired outcomes for those they work with.[8] A SC effectiveness questionnaire has been developed and will be piloted by the end of 2011.[9] Indications are positive that this questionnaire can be piloted in the U.S. in conjunction with the IIP.[10]
The Resistance Dynamic
During the six-year life of the IIP only a small percentage of those invited have agreed to participate. Reasons for declining to do so have included: concern that confidentiality is somehow being breached; the term ideal promises the impossible; the term intervention does not respect the nature of SC; one educator said, "We are already doing that," but turned down the invitation to have students contribute their work to the IIP/SC knowledge base anyway; student work cannot be construed as contributing to best practices; use of the IIP could lead to "cookie-cutter," formula-driven SC; the IIP assumes no place for the spontaneous response that unpredictably meets the SC need of the moment; the terminally ill cannot report IIP interventions' effectiveness. These objections have been addressed in various issues of the Ideal Intervention Project e-Newsletter. (See archives on the ACPE Research Network and East Central ACPE Region websites.) However, when considered together, these objections suggest a perceived affront by the IIP to the sacred nature of SC itself, as expressed in this statement: "It is not even possible, much less right, to try to 'deconstruct' the Mystery in SC."
The Resistance Dynamic Addressed
IIP procedure fully respects the sacred nature of SC while striving to integrate the best from both the Evidence Based Practice (EBP) and Narrative Based Practice (NBP) models. SC is historically and philosophically positioned solidly at the center of NBP. In NBP practitioners interpret the client’s problems with elements of that client’s individual story; anecdotal experiences and intuition are primary in clinical decision-making.[11] EPB in this context is understood to be a thoughtful integration of the best available evidence, coupled with clinical expertise, but does not assume that all clinical observation is totally objective and therefore should, like all scientific measurements, be reproducible.[12] This integrative process, when mastered with the help of the IIP, weaves a profoundly healing fabric from the best threads of science, art and the Mystery.
Conclusion
A SC colleague has wisely summed up all of this in saying, "If professional SC does not find a 'middle course' that produces a way to be true to its heritage and practice while also producing evidence of its effectiveness, no one will fund it. The religious communities can no longer do it and health care (and other) institutions will only do it if there is evidence for its effectiveness."[13] The IIP embodies this middle course.
(Rev) John J. Gleason, DMin, BCC (Retired)
ACPE Supervisor Emeritus
IIP Coordinator
August, 2011
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[1] Paul Starr, The Social Transformation of American Medicine. N.Y.: Basic Books, 1982. 15.
[2] Ibid.
[3] The Indianapolis Star, July 30, 2011.
[4] http://www.healthcare.gov/law/about/order/byyear.html
[5] Sources requested anonymity.
[6] The Commonwealth Fund.
[7] David Leonhardt, "Stand and Deliver," The New York Times Magazine, September 5, 2010.
[8] Harriet Mowat, "The Potential for Efficacy of Healthcare Chaplaincy and Spiritual Care Provision in the NHS (UK)." 2008.
[9] Iain J. M. Telfer, Email message, December 26, 2010.
[10] Harriet Mowat, Email message, July 22, 2011.
[11] Trisha Greenhaigh, "Narrative Based Medicine in an Evidence Based World," British Medical Journal Vol. 318. 30 January 1999.
[12] www.biomed.lib.umn.edu
[13] Anonymous Journal of Pastoral Care & Counseling reviewer, quoted in John J. Gleason, "Guest Editorial: Evidence Based Standards of Care in Pastoral Practice," The Journal of Pastoral Care & Counseling, 60:3, Fall 2006. 198.
