December 2021 Article of the Month
by John Ehman, Editor, ACPE Research Article-of-the-Month
and Manager for Pastoral Care, Penn Presbyterian Medical Center, Philadelphia PA
White, K. B., Combs, R. M. and Decker, H. R. "Board certification of professional chaplains: a qualitative study of stakeholder perspectives." Journal of Health Care Chaplaincy (2021): online ahead of print.
[Editor's Note: Because this article is available ahead of print, no final page numbers can be cited. References are to manuscript [MS] page numbers.]
SUMMARY and COMMENT: While certification has long been a topic in chaplaincy circles, what has become known as "board certification" gained currency only in recent years. The "title of 'board certified chaplain' did not come about until 1995" [MS p. 2], as a function of the continued development of -- and collaboration between -- chaplaincy organizations, and especially the creation of the non-profit Board of Chaplaincy Certification Incorporated (BCCI), which in 1993 began "to conduct the certification process for [the Association of Professional Chaplains (APC)], ...in order for [the APC] to receive tax exemption" [MS p. 2]. A certification process is now quite well established and increasingly part of the professional landscape for chaplains, but "very little published literature documents healthcare chaplains' perspectives on the process" [MS p. 1]. So, in 2019, "[t]o explore what healthcare chaplains working in U.S. settings think about chaplaincy board certification, APC and [the National Association of Catholic Chaplains (NACC)] partnered with a research team at the University of Louisville to interview recent certification candidates, practicing chaplains, certification team members, and chaplaincy managers" [MS p. 2] --a move that the authors of our featured article describe as "a program evaluation rarely seen among professional organizations" [MS p. 15].
A convenience sample of fifty members of the APC and NACC were interviewed 20-75 minutes by phone, and the data were analyzed by a research team that included one board certified chaplain (who did not conduct interviews with chaplains she knew). To gain a range of perspectives, the project intentionally sought "eligible participants in five categories: (1) chaplains certified in the past two years, (2) chaplains who applied for certification without receiving it in the past two years, (3) certification committee members who served in the past two years, (4) chaplains with 7 or more years of experience, and (5) managers of chaplaincy departments" [MS p. 3]. A detailed interview guide is provided in the article's Appendix 1. Generally, though:
Interviewers asked recent candidates about their board certification process, how they conceptualized "competence," and other areas that warranted further attention. Participants who had served as committee members discussed their training in preparation for evaluating candidates, techniques used to assess competence, committee experiences, and thoughts about the process' effectiveness. Researchers asked experienced chaplains about their general perceptions about board certification, their own educational background, to describe certifications' value, and the larger implications of board certification. Researchers asked department heads about employment certification requirements, to describe the concept of "competence" as related to chaplaincy, if they allow their employees to serve on certification committees, and if they thought the certification process effectively evaluated candidates. All participants discussed their views about certifications' value, its importance for their context, and identified strengths and areas of improvement within the process. [MS p. 4]
Among the results:
PREPARING FOR CHAPLAINCY
PREPARING FOR CERTIFICATION AND THE CERTIFICATION INTERVIEW
- Theological Education --
- "Participants explained that their formal education challenged their thinking about theological concepts but rarely focused on specific chaplaincy skills. ...Those who had access to a chaplaincy class or track as part of the degree suggested that the training enhanced their chaplaincy skills. The classes mentioned by participants included counseling skills, interfaith chaplaincy, and religious ethics." [MS p. 5]
- Clinical Pastoral Education --
- "The clinical education and experience that CPE offered received much praise.... The training strengthened participants' self-reflection abilities and coached them about seeking and receiving feedback from others. CPE units were often described as a 'period of growth'...." [MS p. 5] When participants expressed mixed emotions about CPE, they attributed that to the CPE Educator.
CONSIDERATIONS FOR THE PROFESSIONAL CHAPLAINCY WORKFORCE
- Mentoring --
- "Candidates often identified] a 'mentor' to support them through the certification process" [MS p. 6], seeing a mentor as "strengthening one's preparation" and, in the cases of candidates who struggled with the process, "improve[ing] the probability of success." [MS p. 7] Many participants thought that mentors should be required. "A mentor proof reading and editing a candidate's written application provided reassurance." [MS p. 7]
- The Written Application --
- Participants expressed some concerns that "the page limit often hindered efforts to respond and provide their clinical example." [MS p. 7] "Committee members used competency essays to evaluate candidates' articulation of complex ideas and ability to write professionally." [MS p. 8] "Both committee members and candidates valued verbatims. Committee members explained that verbatims informed their decision about a candidate's appropriateness for board certification. Specifically, verbatims provided insight about how candidates applied skills related to the competencies. ...Verbatims enabled candidates to think about the competencies in more depth. ...Participants who discussed endorsement, without receiving a direct question about it, noted it as a source of accountability, wondered about the process for non-Christian candidates, considered it to lack meaning outside the profession, or shared their own time-consuming experience." [MS p. 8]
- Committee Preparation --
- "The training to serve on a certification committee appeared inconsistent across interviews; some described extensive training and others described minimal to none." [MS p. 8] "Candidates, experienced chaplains, and committee members all believed that a candidate's experience with the process could depend on the committee composition, which varied from interview to interview." [MS p. 9]
- The Certification Interview --
- "Commonly, candidates wished for additional guidance in order to anticipate questions and prepare response strategies. Candidates appreciated the use of probing and direction by committee members when a question seemed vague or confusing." [MS p. 9] Candidates seemed to appreciate questions that had the nature of curiosity (as opposed to a more adversarial nature) and "believed they had adequate opportunities to demonstrate their chaplaincy skills." [MS p. 10] Candidates were aware of group dynamics in the interview, and "[c]ommittee members often reflected on the significance of external first impressions and articulated the importance of direct responses from candidates" [MS p. 10], versus vague responses. Also, committee members commented on their uncertainty when a candidate presented strong written material but struggled in the interview, and when the "written materials required them to address too many competencies in the hour allotted." [MS p. 10]
- Certification Interview Results --
- "Rarely did candidates reflect on receiving their results if they received certification. ...Confusion arose from an unclear understanding about why and how competencies were not demonstrated sufficiently." [MS pp. 10-11]
- The Difficulty and Ease of Specific Competencies --
- "Competencies in the area of Integration of Theory and Practice alongside Professional Identity and Conduct were discussed most frequently. Challenging competencies included those that evaluated both practical application and theoretical analysis of topics; these also seemed to evoke the most discussion. ...Competencies that focused on self-evaluation or basic caring/advocating skills were considered easier than theoretical competencies...." [MS p. 11]
- Other Certification Reflections --
- "In some cases, chaplains wondered what the certification experience looked like for non-Christian chaplains and how committees and organizational practices adapted for individuals of other faiths." [MS p. 11] Suggestions included the potential use of video or patient encounter simulations.
- Hiring Chaplains --
- Most hiring managers "noted that they utilize the certification competencies to guide behavioral interviewing" and that they "prioritize the assessment of interpersonal skills and are '...looking to see that [potential hires] can be self-reflective and that they are in tune with their strengths and weaknesses.'" [MS pp. 11-12] Also, "[a] number of managers mentioned preferring job applicants who the manager would want or could see as their own chaplain." [MS p. 12]
- Value of Certification --
- "Inside the profession, certification indicates the requisite education and experience..." [MS p. 12], and "provides a common terminology among other clinical disciplines as well as indicate[s] a certain level of skill." [MS p. 13]
- Defining a Professional Chaplain --
- "Chaplains reflected on the meaning of competence throughout the interviews while often interchanging the words 'effective' and 'professional.' Other descriptors included 'compassionate', 'skilled communicators', 'educated', 'curious', 'empathetic', and 'self-aware'.... ...Participants frequently expressed that a chaplain's ability to practice skills grounded in theory indicated professional competence." [MS p. 13]
The authors note: "This research provided the first in-depth examination of chaplaincy board certification from multiple perspectives" [MS p. 14]. They emphasize in their Discussion section that the study...
...demonstrated divergent views on many aspects of board certification, but on the whole participants respected and valued the process. Managers predominately prefer board certified chaplains and most chaplains indicated that they prioritized their own certification. Chaplains with varying levels of experience discussed how board certification strengthens multidisciplinary respect and collaboration. Participants reported difficulties with competencies that required translating between theory and practice, further suggesting potential educational needs within the field of chaplaincy. [MS p. 13]
Avenues identified for future research include the use of larger sample sizes, greater attention to the voices of underrepresented demographic groups, and "engaging certification leaders and [Certified Educators] about how best to connect educational content to certification competencies" [MS p. 15]. The authors additionally state:
Finally, although participants identified that board certification offers a level of quality assurance, no chaplains connected certification to safety. Given that other disciplines note this connection, this may also merit further examination. [MS p. 15]
A few comments about the article: First, participant quotes are nicely integrated into the thematic points. Second, the interview guide provided in the Appendix is extensive (6 pages) and not only indicates the thoroughness of the methodology but the adeptness required of the interviewers. This would be an instructive document to examine closely for any chaplain researcher seeking to develop a project interview guide. Third, this reader found it curious that there was no mention of how chaplaincy organizations' conference workshops or online resources (webinars, guides, etc.) could help candidates prepare for certification. In fact, the absence of comments about the role of the Internet in the certification process is striking. Fourth, the interviews were conducted between July and August of 2019 (stipulated in a personal communication to ACPE Research from the principal author), prior to the COVID-19 pandemic. This raises the question of how the pandemic may have affected experiences of, and perspectives on, the certification process. Fifth, the theme of the Value of Certification is covered only very briefly, leading this reader to wonder why that apparently wasn't a more salient factor in the data. Could it be the result of having been explicitly brought up only in the interviews with committee members? The perceived value of both the certification process and the certification credential could be a focus of future research. And sixth, the term stakeholder is used in the title of this article (though oddly nowhere else in the text itself, apart from the abstract), and this implicitly signals the relevance of this study. For research, the word points to the population sample as being well placed for data sourcing, but in a larger sense it points up the dynamic of individuals' personal involvement that speaks to motivation and investment in the profession and its organizations. It may be a critical term for the current period of change and development in the world of chaplaincy.
Suggestions for Use of the Article for Student Discussion:
Timing the use of this month's article may depend greatly upon how certification figures into a CPE program's curriculum. It could help students prepare at the outset for the certification process, or it could have value as a means for students to assess and reassess their progress well into their program. For example, a close look at the table of Competencies Discussed by More than 1 Study Participant [Table 2 on MS p. 12] may help students identify specific areas for their professional development. In general, discussion could begin by asking students what findings most grabbed their attention, and why. In light of the article as a whole, do they think about their chaplaincy training in terms of preparing for certification, or do they assume that their training through a particular program will result in their overall competence? If the latter, how do they understand their responsibility as adult learners and the place of individual learning contracts? Who besides their CPE Educator might be a mentor who could help them prepare for the certification process, especially regarding the written application? Do they think of certification as a proverbial hoop-jumping exercise or as something more substantially related to their professionalism? Do any of the group members worry about how the certification process may hold subtle biases problematic to their pathway through it? The group might consider the descriptors used by study participants to define a "professional" chaplain [MS p. 13] and brainstorm about what terms the students believe to be definitive. How might the concept of safety be related to a chaplain's professionalism? One of the themes in the article is the importance of bringing together theory and practice. Does this resonate with the group, and how much are they intentional about making this connection in their own work and education? Finally, research like this study may help a profession come to understand itself at a particular time in its evolution. What does the group think is the main takeaway from this particular snapshot of chaplains' perspectives?
Related Items of Interest:
I. Our featured article references [MS p. 3] a larger report of the research project:
White, K. B., Combs, R., Johnson, R. and Gurung, I. "Professional health care chaplaincy certification: exploring efficacy and strategizing future directions" (National Science Foundation Center for Health Organization Transformation Report No. Pop2). Louisville, KY: University of Louisville School of Public Health and Information Sciences. (March 31, 2020).
At present, this 65-page report is not published in any public form. However, for chaplain researchers interested in access in order to further this area of study, please contact principal author Kelsey B. White (email@example.com) or ACPE Research Article-of-the-Month Editor John Ehman (firstname.lastname@example.org).
II. It may be an interesting exercise to compare the insights from this month's article about the board certification process with those of a 2016 study of ACPE certification committees for Supervisory Education Students (now called Certified Educator Candidates). See our April 2016 Article-of-the-Month.
Ragsdale, J. R., Orme-Rogers, C., Bush, J. C., Stowman, S. L. and Seeger, R. W. "Behavioral outcomes of supervisory education in the Association for Clinical Pastoral Education: a qualitative research study." Journal of Pastoral Care and Counseling 70, no. 1 (March 2016): 5-15. [(Abstract:) This study advances the work of developing a theory for educating Clinical Pastoral Education (CPE) Supervisors by describing the behaviors which result from the successful completion of CPE supervisory education. Twenty-eight Association for Clinical Pastoral Education (ACPE) Certification Commissioners were interviewed to identify the behaviors demonstrated by Supervisory Education Students (Candidates) which influenced the decision to certify them at the level of Associate Supervisor. Specific behavioral descriptors are listed for each ACPE supervisory competency.]
III. At the Association of Professional Chaplains' 2016 annual conference (Lake Buena Vista, FL), the APC shared the results of an online survey of the organization addressing the overall issue of how APC chaplain feel about their work. For a brief report of this self-study appeared in the September 2016 APC Forum News, but see the following full article:
Oliver, R., Hughes, B. and Weiss, G. "A study of the self-reported resilience of APC chaplains." Journal of Pastoral Care and Counseling 72, no. 2 (June 2018): 99-103. [(Abstract:) Approximately 5000 members of the Association of Professional Chaplains were surveyed using the Professional Quality of Life instrument in order to assess levels of Compassion Satisfaction and Compassion Fatigue and its associated subscales, Burnout and Secondary Traumatic Stress; 1299 surveys were completed. The most significant finding of this study is that Board Certified Chaplains have remarkably low scores of Burnout and Secondary Traumatic Stress and significantly high levels of Compassion Satisfaction.]
IV. The queation of the relationship between CPE curricula and certification competencies has been explored in:
Fitchett, G., Tartaglia, A., Massey, K., Jackson-Jordon, B. and Derrickson, P. E. "Education for professional chaplains: Should certification competencies shape curriculum?" Journal of Health Care Chaplaincy 21, no. 4 (2015): 151-164. [(Abstract:) The growing importance of professional chaplains in patient-centered care has raised questions about education for professional chaplaincy. One recommendation is that the curricula of Clinical Pastoral Education (CPE) residency programs make use of the chaplaincy certification competencies. To determine the adoption of this recommendation, we surveyed CPE supervisors from 26 recently re-accredited, stipended CPE residency programs. We found the curricula of 38% of these programs had substantive engagement with the certification competencies, 38% only introduced students to the competences, and 23% of the programs made no mention of them. The majority of the supervisors (59%) felt engagement with the competencies should be required while 15% were opposed to such a requirement. Greater engagement with chaplaincy certification competencies is one of several approaches to improvements in chaplaincy education that should be considered to ensure that chaplains have the training needed to function effectively in a complex and changing healthcare environment.]
V. The methodology of our featured study was guided by Constructivist Grounded Theory. To understand more about this theoretical model in particular, the following articles out of the nursing literature may offer useful background and clarification.
Higginbottom, G. and Lauridsen, E. I.
"The roots and development of Constructivist Grounded Theory." Nurse Researcher 21, no. 5 (May 2014): 8-13. [(Abstract:) AIM: To deconstruct how Charmaz's constructivist grounded theory (CGT) evolved from the original ideas of Glaser and Strauss, and to explore how CGT is similar to and different from the original grounded theory (GT). BACKGROUND: The origins of GT date to 1967 with Glaser and Strauss's study of the treatment of dying individuals, applying an inductive method allowing for the development of theory without the guidance of a preconceived theory. CGT moves away from the positivism of the Glaserian and Straussian GT schools, approaching GT through a constructivist lens that addresses how realities are made. DATA SOURCES: This article does not involve the collection and analysis of primary data; instead, academic literature written by leaders in the field of GT was reviewed to generate the ideas presented. REVIEW METHODS: Comprehensive literature review drawing on the 'integrative review' principles. DISCUSSION: When selecting a GT approach, the possibility of a congruence between the chosen methodology and the worldviews of the researcher's discipline and own outlook should be considered. CONCLUSION: The differences among the various schools of GT lie in their overarching goals and their perspectives of the nature of reality. IMPLICATIONS FOR RESEARCH/PRACTICE: Considering the alignment between the constructivist worldview and the field of nursing, CGT offers a valuable methodology for researchers in this area.]
Mills, J., Bonner, A. and Francis, K. "Adopting a constructivist approach to grounded theory: implications for research design." International Journal of Nursing Practice 12, no. 1 (February 2006): 8-13. [(Abstract:) Grounded theory is a popular research methodology that is evolving to account for a range of ontological and epistemological underpinnings. Constructivist grounded theory has its foundations in relativism and an appreciation of the multiple truths and realities of subjectivism. Undertaking a constructivist enquiry requires the adoption of a position of mutuality between researcher and participant in the research process, which necessitates a rethinking of the grounded theorist's traditional role of objective observer. Key issues for constructivist grounded theorists to consider in designing their research studies are discussed in relation to developing a partnership with participants that enables a mutual construction of meaning during interviews and a meaningful reconstruction of their stories into a grounded theory model.]
Mills, J., Bonner, A. and Francis, K. "The development of Constructivist Grounded Theory." International Journal of Qualitative Methods 5 (2006): 1 [online journal article designation]. [(Abstract:) Constructivist grounded theory is a popular method for research studies primarily in the
disciplines of psychology, education, and nursing. In this article, the authors aim to locate the
roots of constructivist grounded theory and then trace its development. They examine key
grounded theory texts to discern their ontological and epistemological orientation. They find
Strauss and Corbin's texts on grounded theory to possess a discernable thread of constructivism
in their approach to inquiry. They also discuss Charmaz's landmark work on constructivist
grounded theory relative to her positioning of the researcher in relation to the participants,
analysis of the data, and rendering of participants‟ experiences into grounded theory. Grounded
theory can be seen as a methodological spiral that begins with Glaser and Strauss‟ original text
and continues today. The variety of epistemological positions that grounded theorists adopt are
located at various points on this spiral and are reflective of their underlying ontologies.]
Tie, T. C., Birks, M. and Francis, K.
"Grounded theory research: a design framework for novice researchers." SAGE Open Medicine 7 (2019): 2050312118822927 [online journal article designation]. [This article is of note both for its aim of offering guidance to novice researchers and for its quite straightforward differentiation of a "constructivist" approach from "traditional" and "evolved" approaches to grounded theory.]
It may also be useful for chaplains to look at a couple of other examples of chaplaincy research employing Constructivist Grounded Theory:
Raffay, J., Wood, E. and Todd, A. "Service user views of spiritual and pastoral care (chaplaincy) in NHS mental health services: A co-produced Constructivist Grounded Theory investigation." BMC Psychiatry 16 (2016): 200 [electronic journal article designation]. [(Abstract:) Background: Within the UK National Health Service (NHS), Spiritual and Pastoral Care (SPC) Services (chaplaincies) have not traditionally embraced research due to the intangible nature of their work. However, small teams like SPC can lead the way towards services across the NHS becoming patient- centred and patient-led. Using co-production principles within research can ensure it, and the resulting services, are truly patient-led. Methods: A series of interviews were conducted with service users across directorates of a large NHS mental health Trust. Their views on the quality of SPC services and desired changes were elicited. Grounded theory was used with a constant comparative approach to the interviews and analysis. Results: Initial analysis explored views on spirituality and religion in health. Participants' concerns included what chaplains should do, who they should see, and how soon after admission. Theoretical analysis suggested incorporating an overarching spiritual element into the bio-psycho-social model of mental healthcare. Conclusions: Service users' spirituality should not be sidelined. To service users with strong spiritual beliefs, supporting their spiritual resilience is central to their care and well-being. Failure will lead to non-holistic care unlikely to engage or motivate.] [This article is available freely online from the journal.]
Townsend, L. L. "Research report: a grounded theory description of pastoral counseling." Journal of Pastoral Care and Counseling 65, nos. 3-4 (Fall-Winter 2011): 1-15 [electronic journal pagination]. [(Abstract:) Historically, clerical paradigms of ordained ministry have defined pastoral counseling. However, these fail to describe pastoral counselors in the complex social, theological and medical contexts in which they now work. This study asks the question: How do pastoral counselors in clinical practice describe what is uniquely “pastoral” about the counseling they offer clients? Grounded theory was used to propose a preliminary description and an intermediate theory of how pastoral counselors interpret “pastoral.” Eighty-five pastoral counselors were selected for the study over a four-year period using criteria to assure maximum variation. Interviews and pastoral identity statements were collected and coded, and theoretical models were organized using NVIVO, a computer assisted qualitative design and analysis software (CAQDAS) package. Results suggest that pastoral counselors share some common ideas regarding “pastoral identity” and clinical practice. How pastoral counselors interpret “pastoral” is highly context sensitive and varies widely.