The Chaplain as a Member of the Multidisciplinary Team- An Ethical Risk?

1. The Chaplain as a Member of the Multidisciplinary Team-An Ethical Risk? Janet Young, Mary-Lou Martin, Rosemary Garside, Sandra Berzaitis-Smith, Kathy Carlin, Gwen Davidson

2. Background • Chaplains have been an integral part of the clinical team • Debate about whether chaplains should be part of the clinical team in mental health • Potentially conflict between the needs of the client, the team & spiritual care provider

3. Practical Question • Should there be standard guidelines related to this issue?

4. Ethical Questions • How does the chaplain meet clients’ spiritual needs? • How can clients benefit from spiritual care & how can any harm be avoided? • Should chaplains protect the confidentiality of clients’ personal information? • Should chaplains be expected to disclose clients’ information to the clinical team & vice versa?

5. Ethical Questions • Should chaplains document & have access to the client’s casebook? • What happens to inter-professional collaboration when one party does not share information? • What is the duty of the chaplain who has a client disclose to them a risk of harm to self or others? • What is the responsibility of the employer in this situation?

6. Spirituality • “The search for the sacred. A conscious striving to move beyond isolation and self-absorption to a deeper awareness of interconnectedness with the self, other human beings and the transcendent.” (Catholic Health Association of Canada 2000, p. 102)

7. Religion • “The expression of spirituality through traditions, rites and practices usually within the context of an organized faith.” (The Catholic Health Association of Canada, 2000, p. 100).

8. Spiritual & Religious Care • “The activity of chaplains, community clergy, faith leaders and laity in helping persons to discover and deepen life and give expression to their spirituality and/or religion.” (The Catholic Health Association of Canada, 2000, p. 102)

9. Reasons To Include Spirituality & Religion In Mental Health Services • Reflection of consumer self-understanding • Facilitation of recovery • Enhancement of cultural sensitivity of services • Positively related to psychosocial well-being (Fallot, 2001)

10. Barriers To Spirituality • History of mental health treatments • Professional stereotypes • Confusion & fear about the meaning of spirituality (Longo & Peterson, 2002)

11. Helping Relationship • Trust • Respect • Honesty • Confidentiality • Privacy • Quality care

12. Confidentiality • “Confidentiality is a quality of human communication that protects a person’s right to privacy by fostering trust between the care provider and the person receiving care. Confidentiality excludes unauthorized persons from gaining access to information concerning the person receiving care, and requires that people who have such information refrain from communicating it to others” (The Catholic Health Association of Canada, 2000, p. 94)

13. Protecting Confidentiality • What measure are in place? • Do clients have the right to expect & assume that chaplains will not disclose personal information? • Are their limits to the bounds of confidentiality • Should the chaplain only disclose information as authorized by the client

14. Protection of Privacy • “Every person has the right to privacy. This includes privacy of personal information, confidentiality, and freedom from the unwanted intrusions of others in their immediate situation. This privacy must be carefully respected by care providers in their professional and informal conversations….Exception to the right of privacy must be clearly justified by those claiming them. Exceptions may be justified in situation where the right to privacy is limited by the dematnd of the common good.” (The Catholic Health Association of Canada, 2000, p. 33)

15. Free & Informed Consent • Capacity • Possible risks • Benefits • Best interests

16. Perspective Of The Chaplain

17. Role of Chaplain? • Wall-Mart greeter • Advocate • Touchstone in crisis • Parish Priest • Confessor • Officiator at celebrations • Communicator of bad news

18. Clients Describe Chaplains… • Hey Chaplain! • Sister • Pastor, Reverend or Minister • Priest • Hospital Mother • Friend • “Charlie”

19. Community Faith Leaders’ Expectations • Authority figure • Keeper of confidences • Faith expert • Evangelist • Always compassionate will no time restraints • Someone to show your best side to • Representative of what has wounded/ rejected in the past • Connection with the Divine

20. Chaplains’ Perspective • Trained professional • Masters Degree in Theology/Pastoral Counselling • Specialist in Clinical Pastoral Education with CAPPE/ACPEP • Code of Ethics • Faith Group Endorsement for Institutional Ministry • Multifaith Training and Evaluation

21. Chaplain’s Perspective • Oversee Spiritual Care at CMHS • Place & Mentor Students • Support Volunteers & Community Clergy • Provide Crisis Support for Staff • Provide Education on Spirituality • Subject to PHIPA & Hospital Policies & The Ontario Human Rights Code regarding Creed • Work Within the Recovery Model • Member of the Ethics Committee

22. How Can A Chaplain Minister To People Of Other Faiths? “Some chaplains may, in fact, agree that religiosity is merely one expression of spirituality yet claim that, because all patients are spiritual beings, they should routinely be visited by a chaplaincy service because chaplains have "special expertise" in all matters spiritual.” Leowy & Leowy (2007, p. 53)

23. “ Being a person of faith exposes one to what is held in common with other faiths” e.g. moral values, choices, worship, prayer, limitations, aha moments, community, etc.”

24. Values That Promote Care Sensitive To Culture • Equality: All persons are equally, fully human, equally deserving of positive regard. • Mutuality: Human beings are relational beings who are fully alive in reciprocal exchange • Integrity: All persons are responsible individuals capable of thinking their own thoughts, feeling feelings, choosing options. (Augsburger, 1986)

25. Additional Values That Promote Care Sensitive To Faith • Humility: Always being open to one’s own fallibility • A Sense of Wonder: Taking delight in the unexpected and new as well as recognizing the beauty and grace revealed in everyday life.

26. Unique Perspective “This strategy does not call for the healthcare provider to become an expert in cultural minutae…Ideally, being appropriately cognizant and responsive to cultural issues should not be thought of as reaching a ‘competency’ so much as engaging in an ongoing process of honing and applying skills for self-awareness and for respectful recognition of the unique perspective each patient brings to the clinical encounter.” (Hunt, 2001, p.1882)

27. Can A Chaplain Provide Counselling?

28. CAPPE Code of Ethics • supports disclosing information “for necessary treatment, ..for the safety of any person or as required by law.” Otherwise disclosure requires client permission. • Members are subject to the law in their jurisdiction. • The code also deals with knowing the limits of one’s expertise and working with and making referrals to other professionals “whenever it is in the best interest of those being served.” (CAPPE, 2007)

29. Psychotherapy Defined The practice of psychotherapy is the assessment and treatment of cognitive, emotional or behavioural disturbances by psychotherapeutic means, delivered through a therapeutic relationship based primarily on verbal or non-verbal communication. (Pychotherapy Act, 2007, p. 118)

30. Should A Chaplain Keep A Client’s Confidentiality? “…..we suspect that most patients assume that chaplains in the healthcare setting operate on much the same principles as do clergy -- if I confide in my clergyperson, I can expect strict confidentiality (unless, of course, what I have confided places another at risk). I assume that a chaplain is also bound by that strict confidentiality unless I am explicitly told otherwise.” (Loewy & Loewy, 2007, p.53)

31. CAPPE Code of Ethics • No clear guidance • It requires that we enter chart notes • there is judgment required as to what is necessary to communicate for the benefit of the client. (CAPPE, 2007, p. 118)

32. Perspective Of The Consumer

33. My Story – My Journey • My life • My mental health • My religion • My experience • My profession – occupational therapist • My spirituality • My recovery

34. Spirituality Defined • “Sensitivity to religious values: practice of personal devotion and prayer. Relating to one’s spirit and higher consciousness as distinct from one’s earthbound body and nature”

35. Perspective Of The Recreational Therapist

36. Therapeutic Recreation • Therapeutic recreation is a process that utilizes treatment, education & recreation participation to enable persons with physical, cognitive, emotional &/or social limitations to acquire &/or maintain the skills, knowledge & behaviours that will allow them to enjoy their leisure optimally, function independently with the least amount of assistance & participate as fully as possible in society.

37. Recreational Therapists’ Intervention • What is meaningful to the person • Goals are based on the person’s expressed needs • Standard assessment tools specific to spirituality

38. Therapeutic Recreation (TR) Issues • Therapeutic recreation may not be supported as treatment • Spirituality is incorporated into TR practice • TR has commonalities with other professions • Complimentary service between TR & chaplaincy/spiritual care • Joint interventions

39. Spirituality… • Common experience connecting us • Search for meaning & purpose • Connectedness & hope

40. Contact Info • Janet Young jyoung@stjosham.on.ca Mary-Lou Martin martinm@stjosham.on.ca