Collaboration Between Hospital Social Work and Pastoral Care to by mwv14394


									Collaboration Between Hospital Social
Work and Pastoral Care to Help Families
Cope With Serious Illness and Grief
Curtis             W. Hart,                    M.Div.
Susan              Matorin,                     M.S.,             A.C.S.W.

The       authors            describe               an educational                         program            for hospital                  chaplains                 based              This          paper          describes                  a training
on a partnership                      between    pastoral    care and social                                               work in a teaching                           hos-      program               for hospital               chaplains              that         is
pital. The goal                    of the program      is to train chaplains                                               to use social work                          prin-      based          on a structured                    partnership                  be-
ciples          to maximize                  families’            capacity             to negotiate                 a complex                health            care      sys-     tween            hospital             social          work        and         pas-
tern, to solve                 problems    in a health                              crisis, and              to participate                    constructively                     toral         counseling.               The       program               teach-
on the health                   care team.    Building                              on the two               disciplines’                   shared     values                in   es social             work         concepts,             provides               so-
person-centered,                         process-oriented                         approaches                   to care, the program                                   intro-      cial          worker            mentors                 for       chaplain
duces     chaplain                    trainees      to social                   work concepts                    of crisis intervention                                  and      trainees,              and      facilitates             interdiscipli-
family          systems            theory           that      they       can         apply         in their           interactions                   with      families           nary          case      conferences                   and co-leader-
in their          hospital              and         congregational                         practice.          The          approach                 taught         in the         ship       oftherapy                groups.           The        contribu-
program  is illustrated                               in a case vignette    describing     a chaplain       trainee’s                                                             tion to the health care team ofa chap-
work with the family                                of a child treated   for severe    burns.  (Psychiatric        Ser-                                                           lain trained   in the program     is illus-
vices       48:1549-1552,                      1997)                                                                                                                              trated   in a case vignette   describing
                                                                                                                                                                                  the       chaplain’s            work           with      the      family            of

 M                 anaged
                                      care      has ushered
                                      oftruncated                 hospital
                                                                            in a              take
                                                                                                        a backseat.
                                                                                                             that     animate
                                                                                                                                          a healing
                                                                                                                                                    trends       put
                                                                                                                                                                                  a child           treated

                                                                                                                                                                                  The training program
                                                                                                                                                                                                                      for severe              burns.

                   stays        for       acutely           ill patients                      ment         at risk.                                                               The        clinical            pastoral           education                  pro-
and      rapid        return          to their         families             and                    We        believe            that         the       person-cen-                gram           at the         New       York          Hospital              is ac-
communities                    to complete                  the      recov-                   tered,         process-oriented                           approaches                credited               through            HealthCare                    Chap-
cry process.               In the turmoil                   ofa       health                  of pastoral  counseling                                    and        social        laincy,          Inc.       This       program                trains        year-
emergency,                 family            members              may         be              work can help preserve                                   these       values         ly a group                  of ten        full-time              residents
required              to make          decisions             about           the              in the hospital                  setting.             Collaboration                 who spend     time     at both   the                                        New
use      ofintirnidating                  and       complex             mcd-                  between    the                 two        disciplines              as part          York Hospital     and its neighbor,                                          Me-
ical     technology                in treating               their       rela-                of the          health           care         team         allows            the    morial Sloan-Kettering       Cancer                                         Cen-
tive.      They        may         also       encounter               obsta-                  team         to identify              and      mobilize            the       pa-    ter. They               come          to the residency                       from
des        in     obtaining               insurance               compa-                      tient’s        family          to participate                  construe-            positions               in congregations                        and         semi-
nies’       approval            or       reimbursement                       for              tively        in the          patient’s              recovery.           Part-      naries               and       from        careers               in         other
treatment              and      may          find      that       the       irn-              nership          between                the      two       disciplines              fields.         In addition,               five        to seven             sum-
personal,             institutional                 treatment               set-              can help              the     family          negotiate             a corn-         mer        interns,            most       ofwhorn                are semi-
ting gives little               attention             to their          erno-                 plex         health  care              system,  solve prob-                         nary          students,             come          to fulfill           acade-
tional response                     to their           relative’s            ill-             lems          in a crisis,              and gain access    to                       mic           requirements.                       For         both           resi-
ness.       In such          settings,          efficiency              dorn-                 community                     resources                 for       postdis-          dents           and         interns,           time         in the           pro-
mates,          and     humanistic                  considerations                            charge          support.                                                            gram           is evenly              divided            between                di-
                                                                                                                                                                                  dactic           seminars               and       individual                   and
                                                                                                                                                                                  group             supervision                   and         clinical            as-
                                                                                                                                                                                  signments.                   Supervision                 of      residents
The authors             are affiliated               with     New        York        Hospital-Cornell                     Medical         Center         in New         York
                                                                                                                                                                                  and interns                  is provided                by a certified
City.     The Rev.          Hart       is the director               ofpastoral             care     and education.                 Ms. Matorin              is program
                                                                                                                                                                                  clinical             pastoral           education                 supervi-
directorfor            an intensive              outpatient             program             at the hospital’s               Payne         Whitney            Clinic.       Ad-
dress       correspondence                   to the         Rev       Hart         at New          York      Hospital,          Box         167,      525      East      68th     sor       and        supplemented                     by input               from
Street, New York, New                         York 10021.             An earlier cersion                   ofthts paper              was presented               May 29,          the       hospital’s               pastoral            care       staff.        Al-
1996, in a teleconference                        sponsored             by Telemedicine                     Canada/USA                ofthe   Faculty             of Mcd-          ter       their            training         experience,                      most
icine     ofthe        University            ofToronto            in Toronto,               Ontario,        Canada.                                                               interns              and      residents               return           to     full-

                       December                                      1997           Vol.     48      No.     12                                                                                                                                                1549
time           study            or take                positions                 in con-               have           illustrated            ways           to help           a family               emotions,                   empathy,                  and           connected-
gregations                     or in chaplaincy.                                                       deal with                 the      death  of a child,  the                                    ness        with            community                         supports,                  in-
      In 1985                the clinical                   pastoral                 educa-            identification                   of elder abuse,    how to                                    eluding               religious                resources.                We hy-
tion       program                  began              developing                      basic           respond              to a distraught                       family         in the              pothesize                  that              families                 who   lack
training                  in        the         fundamental                            skills          emergency                     room,          and        the       disruptive                  these           attributes                   will           drain             the        re-
chaplains                      would              need                to        become                 impact            of substance                    abuse           on a fami-                  sources              of the           medical                team            and        can
more                active           players                  on       the           health            ly       system.              About            45       trainees              have            compromise                       the         care           of the           patient.
care        team.              Because                 clergy              who         work            participated                    in the            seminar              since          it      For        families                 with         unremitting                          con-
in       hospitals                  as      well              as       those             who           was       instituted.                                                                         flict     that         is unchecked                         by the            current
serve           in congregations                               routinely                 con-                Basic         concepts                 of      crisis        interven-                  emergency,                    the goal                of the chaplain’s
front          families                in crisis,                  their         clinical              tion       include            the value                oftimely            inter-             intervention                    would                 be      to encourage
training                 needs            to include                   theoretical                     ventions              that       focus            on     the       here        and            the       family             to isolate                    the      conflict              by
guidance                   and       practical                 wisdom                 about            now        and        that       mobilize                strengths             and            containing                   the       time           and          energy               giv-
crisis          intervention.                          In     this area, the                           minimize                regression.                  The        seminar           di-         en to it and                  to direct                as much                 energy
field          of         social          work              has developed                              rects particular    attention                                    to how         the           as      possible               to      the         needs              of      the       pa-
concepts                  and        skills            that        can          be     quite           anxiety  of a health     crisis                                 distorts        the           tient.
valuable                  to chaplains                   in hospitals                       and        ways           in which           families              present           them-                   As hospitals      treat                            a more                 diverse
to congregational                                 clergy.              Just           as so-           selves           to hospital                staff.                                            patient   population,                                 attention                to the
cial       work            has come                    to appreciate                        the                                                                                                      place           of     culture               and           religion             in      the
role       of spiritual                    values             in patient                 care                                                                                                        life     of the             patient             becomes                    essential.
( 1), pastoral                   care       programs                     can derive                                                                                                                  For example,                        the       hospital’s                   psychiat-
considerable                              advantage                             from               a                                                                                                 nc division                  has worked   with                                a rabbi
grounding                      in crisis          intervention                         theo-                                 Pastoral                       care                                     from   the                  Hasidic  community,                                  who
ry and family                        systems                  theory.                                                                                                                                has       played               a vital              role           in bringing
      The           two        professions                     share            a signif-                        programs                          can            derive                             community                     members                      into      treatment.
icant          value           base.            Both          disciplines                   en-                                                                                                             Grief          work           is a critical                     aspect                 of
dorse           the        concept               ofclient                  self-deter-                       considerable                                advantage                                   family               practice                   for          chaplains                     in
mination    and support    a vigorous                                                     role                                                                                                       health           care.          Families                   face       many             rca-
for patient    choice  in the health                                                     care          from               a grounding                                  in crisis                     Sons       for        grief         in the            hospital                setting.
experience.                      Both           address               the       unique-                                                                                                              Besides               the       death            of a relative,                       they
ness        of the             individual                   and the signifi-                                          intervention                             theory                                may        include              a diagnosis                       of a fatal dis-
cance               of       patients’              life           narratives                   as                                                                                                   ease,       the        birth          ofan          impaired                  child,           a
they           struggle              to find                meaning                  in the                           andfamily                             systems                                  debilitating                     stroke,               infertility,                     and
face           of        life-threatening                             illness.              We                                                                                                       disfiguring                  injuries               (4).      Families                who
believe               these          themes              are endangered                                                                 theory.                                                      are able to tolerate         and encourage
in       the         current               health               care            climate,                                                                                                             different     styles   of grieving    among
where                    increasingly                          sophisticated                                                                                                                         their     members      will be able     to go
technology,                      an emphasis                          on efficien-                                                                                                                   through     the grieving    process  without
cy,       and            a paternalistic                             posture                can                                                                                                      professional                    intervention.                         For       exam-
override                       more                person-centered,                                          Family            systems              models               encourage                   plc,       a higher-functioning                                      family             un-
process-oriented                                approaches.                          A vig-            the       trainees             to recognize                     the      critical             derstands                    that          an         adolescent                      may
orous                partnership                        between                       social           role       of the            family          in healing                and      the           need        to rollerblade                        on the day he los-
work           and           pastoral             care          would                have          a   stress           experienced                      by       family            care-            es a parent                   or that           an individual                         who
vital          role          in preserving                            therapeutic                      givers.             The         training                program                dis-           relies on work to cope may                                                 return             to
processes                    that         are      critical                to    the        pa-        courages                the      historical                tendency                  in       the job soon after a funeral.
tient’s             and        family’s            ability             to cope.                        the       mental             health          disciplines                to ana-                  Murray       Bowen’s                               family                 systems
      The             clinical              pastoral                       education                   lyze       family            behavior                and ascribe               psy-           theory    outlines     the                            effects               of unre-
program                   at New                York           Hospital                inte-           chopathological                        motivations                    to family               solved           grief          across             generations                       (5,6).
grated              material              about             crisis           interven-                 members’                  interactions                   with          hospital               Chaplain                   trainees             are          taught            to rec-
tion        and           family           systems                   in its teach-                     staff.                                                                                        ognize   these effects     among  the fami-
ing       program                   in 1992.             We           organized                    a         To approach                     the      family           in a health                   lies they interact     with in the hospital
two-hour                   introductory                       seminar                 for all          crisis,           trainees              are           encouraged                     to       setting              and      to refer                family           members
chaplain                  trainees                in        which               we       pre-          consider              the       family’s               previous            expe-              who are at risk of becoming                                                 mired in
sent        an           overview                 of        crisis           interven-                 rience            with          health            care          and       health              the griefprocess  to hospital                                              and corn-
tion        and            family           systems                   theory                and        care       workers               and         how         these          experi-               munity     counseling                            resources                   for din-
provide                  selected               bibliographical                             ref-       ences           might          influence                their       response                  ical intervention.
erences                   (2,3).          Participants                          provide                to       the       current             situation.                 We         teach                   Besides             providing                  specific               theoret-
clinical              vignettes                 from           their            practice               that       families             who          cope          well        demon-                 ical      knowledge                        in       the           seminar,               the
experience                   to flesh out essential     the-                                           strate          executive              leadership,                    a capaci-               clinical              pastoral               education                      program
oretical                  tenets.    Clinical   vignettes                                              ty to tolerate                  expression                 of a range                of       allows           trainees              to practice                    their         skills

1550                                                                                                                                                                      PSHIATRIC               SERVICES       +        December              1997             Vol.      48        No.          12
in establishing                       therapeutic                    alliances                 relevant                   to     their           interactions                      with                 The      health            care          team           responded                  to
with          families           in crisis,              in identifying                        families              in health                 care        settings.           They               this      child        with         their           usual             deep          corn-
families’    strengths,                         and in encourag-                               also find that the knowledge      is readi-                                                        passion             and         medical               skill         addressing
ing families      to seek                       out resources    for                           ly transferable to practice  in their con-                                                         his      acute            medical                needs.                However,
social          and        spiritual              support             in both                  gregations.                       The            introduction                       to         a   given  the unclear    circumstances                                                     of
the hospital                     and              the community.                               framework                        that addresses                   coping     un-                   the “accident”   in which    he had                                                  sus-
Trainees  gain                  direct            experience  in pa-                           der stress                      and provides                    some     initial                   tamed           the burns,                    the      staff          reacted               to
tient         care      on acute              and        intensive            care             interventions                       to improve                   family             corn-          the mother                   with        suspicion.                   Their          sus-
units in medical     settings                                and on psy-                       munication                       in a crisis                is immediately                         picions             were         fueled              by       the        mother’s
chiatric   units designated                                   to treat se-                     helpful.               Trainees                  have          expressed                  in       inability             to visit            her          son          for several
verely   depressed     elderly                                clients, pa-                      their         evaluations                      a desire             for further                   weeks.
tients         with       acute          psychosis,                and those                   exploration                      of these             and      other        related                   The         patient’s                older sister had been
with          substance              abuse           problems.                                  issues             in follow-up                  seminars.                                        placed          at birth               in the care of the ma-
       Staff social workers     act as mentors                                                                                                                                                    ternal          grandmother.                          Alter             the         acci-
for      the trainees,   helping     them   gain                                                                                                                                                  dent,  the patient’s                             younger    brother
skill        in identifying                   and responding                         to                                                                                                           was removed    from                            the mother’s    home
isolation,             rejection,               loss,      and       other        is-                                                                                                             and        placed              in the           care          of his              father.
sues          that      emerge             in treatment.                     Such                                                                                                                 The burn unit                       staff had compromised
issues           have          spiritual             as well           as psy-                                                                                                                    their capacity                      to form a constructive
                                                                                                          between                         social                work
chological  dimensions     that can use-                                                                                                                                                          alliance              with             this         mother                   by      dis-
fully be addressed     by the combined                                                                                                                                                            cussing              their        suspicions                     of      her         pre-
                                                                                                     andpastoral                                      counseling
approaches                    of the two disciplines                             (7).                                                                                                             surned            responsibility                       for       the         tragedy
       In      addition,               social             workers              and                                                                                                                within          earshot             of her.
                                                                                                      has            helped                    some             clients
chaplain               trainees          participate                 together                                                                                                                            The          chaplain                  intern               intervened
in case           conferences                     and co-lead                ther-                                                                                                                skillfully.             She         persisted                    in      reaching
                                                                                                reconnect                           with              appropriate
apy         groups         in the          hospital’s             substance                                                                                                                       out to this overwhelmed                                            mother     by
abuse             program.                 In        these           settings,                                                                                                                    making   herself available                                       in a consis-
                                                                                                                   religious                     supports
members                 of the         two          disciplines              have                                                                                                                 tent, nonjudgmental       way                                    through    pe-
explored               ideas         about          the role          of spiri-                                                                                                                   riodic telephone    contacts                                     and face-to-
                                                                                                                     in planning                              for
tuality          in recovery.    Whatever                             the pa-                                                                                                                     face         meetings               when             the         mother              spo-
tient’s          medical    or psychiatric                            diagno-                                                                                                                     radically             visited            the        hospital.                The        in-
                                                                                                                         discharge                         and
sis,        specific          themes              that       consistenfly                                                                                                                         tern avoided                     overidentifying                          with         the
arise include      forgiveness,     guilt, self-                                                                                                                                                  ill child and was able to communicate
acceptance,     and hope        in the face of                                                                                                                                                    her understanding          of the guilt the
profound    suffering.     The collaboration                                                                                                                                                      mother    felt, eventually     enai)hng the
between                  social          work             and         pastoral                                                                                                                    mother    to begin  regular                                      daily visits.
counseling                     has         also          helped           some                                                                                                                    With   the intern’s   help,                                      the mother
clients          reconnect               with appropriate    re-                                Case vignette                                                                                     was          able         to      acknowledge                           her          sul)-
ligious           supports               in planning    for dis-                                The following     vignette  illustrates      the                                                  stance          aI)use           problem                   and        to resume
charge   and aftercare.                                                                         therapeutic   role of a chaplain        intern                                                    treatment.                 She      also        was         able         to recon-
   In the last five years                                    the cultural                       and her contril)ution      to the health                                                          nect         with       a church                 she          had        attended
backgrounds     and religious                                  affiliations                     care       team            of the          hospital’s               burn            unit.         and was               thus        able          to renew                  a source
of the trainees                      in the clinical                  pastoral                  Although                   chaplains                  often         have            only          of support.
education                program                  have       become               in-           brief         contacts              with         patients              and         their                 The      chaplain                 intern,              who            like      the
creasingly                    diverse.               Trainees                have               families,                 we       selected                 a longer-term                         patient              and         his          family             was          African
come           to the         program              from          throughout                     case          to illustrate                    more         fully       the         con-          American,                  was          able         to       draw            on      this
the metropolitan                         area           as well        as from                  cepts              and         skills          emphasized                     in        the       shared            identity              in interacting  with                           the
foreign           countries.               Those           who       have        cx-            training             program.                                                                     family.            Besides               using her clinical                             in-
perience                 as       congregational                        clergy                       The            patient,             a nine-year-old                            Afri-         tervention                     skills          to      encourage                       the
have          front-line             exposure                to emergent                        can-American                            boy,         had      fallen          into            a   mother’s                participation                         in       her          son’s
family           and psychiatric                        crises       in a vari-                 tub           of         scalding               water,              sustaining                    treatment,                 the intern                 was able                  to crc-
ety         of community                      settings.              We        now              burns          over 70 percent  ofhis                                  body. His                  ate a cultural     bridge   between       the
pay more attention      in our teaching      to                                                 family          consisted  ofa mother                                   suffering                 troubled    mother      and   the   largely
criticially important      cultural   themes                                                    from a significant                               alcohol and drug                                 white          professional                    hospital                staff.
that impact   on attitudes      about health                                                    problem,  a father                              who had been in-                                         It was many                  months                before             this boy
and illness.                                                                                    carcerated                     for a drug             charge,            two old-                 could          l)e        reunited                  with         his         mother.
   Chaplain                    trainees                 respond              with               er       half-siblings,                         an      older           sister,               a   He was initially                         transferred                    to a reha-
considerable                    enthusiasm                   to the          theo-              younger                    brother,                  and        a      maternal                   bilitation            hospital,  then discharged       to
retical          material             presented                  in the pro-                    grandmother                        who          was        employed                  as a         an aunt,             and finally placed    in a foster
gram.           They          find     that       it is immediately                             cashier              in the         hospital’s                cafeteria.                          home           l)efOre           returning                  to his mother.

PSYCHIA1’RIC             SERVICES .                 December            1997            Vol.   48       No.         12                                                                                                                                                                1551
During                 this             extended                       time,            the       chap-               concerns                    abou          t     their               interactions                                  References
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sights               that              helped                 the          intern’s               work.               the       health            care          team           and         functioning
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        In      retrospect                              in         considering                             this       lv’s capacity                 to niake                 critical            decisions,                                      1997
                                       a     fiuiiilv

                                                          l)V reaching
                                                                       have             deepened

                                                                                                 out          to
                                                                                                                                     in a health
                                                                                                                                                                emergency.                        #{149}
                                                                                                                                                                                                and          retain
                                                                                                                                                                                                                                        8.      Iludson
                                                                                                                                                                                                                                                28,        1996
                                                                                                                                                                                                                                                                                                                       results        of faith.

the          child’s                   grandnothei                                Such            an in-              Acknowledgment
                                                                                                                                                                                                                                       9.       Feder               BJ:           \Iinisters                who           work          among
tergenerational                                         in terven                  tion           could               The          authors          thank             Carolyn              Yard,             D.S.T.,                            their         flock.              New ork                  Times,          Oct        3, 1996,
         increased                                      support                    for           the          ill     for     her      contributions                       to the        case         stud                                      D1,20

child            and                   helped                    the             mother                 and
grandniothei’                                 address                       long-standing
conflicts                   in their                 relationship.

                                                                                                                                                   APA Invites     Applications
                                                                                                                                                   for 1998    Achievement                                                                              Awards
Fhe            usodel                   of’ collaboration                                 we           have
I)resellted                      is based                    on the interdepen-                                                                     Applications                           are          now             being                accepted                         for            the          1998
deuce                of the                  chaplain                      ail          the        social
                                                                                                                                                    Achievement                            Awards,                presented                      annually                         by the Amer-
worker                 on          the         health                 care             team.           This
                                                                                                                                                    ican            Psychiatric                   Association                      to recognize                               programs                      that
nu)clel               requires                       iiiutual                    respect                and
                                                                                                                                                    have              made               outstanding                          contributions                                  to        the          mental
efficient                        use               of           professional                                re-
                                                                                                                                                    health             field. The                     deadline                  for receipt                       of applications                                   is
sources.                    Each               discipline                         nust            retain
                                                                                                                                                    January               16, 1998.
its integrity                              while             renaining                        Opeli           to
a l)lendiflg                           of’ knovledge,                                  skills,          and                                               The          winners                   of the            1998           awards                   will           be selected                             by
values.                                                                                                                                             next year’s  Achievement                                                Awards                       board,                     chaired                  by
       In       our              )rOgram,                          tiiie           constraints                                                      Pierre A. Rioux,    M.D.,                                            of Minot,                      North                      Dakota.                  The
necessitated                               a single,                focused                seminar                                                  awards                 will      be         presented                     at the           Institute                      on       Psychiatric
session                 iii            which                 crisis              iiitervention                                                      Services,                  to be held                     October                  2-fl,          1998,              in Los Angeles.
dfl(l         family                   systems                   theon                  were            dis-
                                                                                                                                                          Applicants                      for the 1998                        awards             will be assigned                                        to one
cUsse(l.                    \Vith                  this            grounding,                              the
                                                                                                                                                    of two                categories                   by the Achievement                                           Awards                     board-
chaplain                      trainees                        were                better               I)re-
                                                                                                                                                    larger            programs                    with           institutional                        or academic                             sponsor-
pared            to use                     their            case           experience                        to
                                                                                                                                                    ship            and      smaller,               community-based                                     programs.                            The           first-
l)uild           their                 partnership                          with           the         hos-
                                                                                                                                                    prize             winner                in each                    categoty                  will             receive                    a $5,000
1)ittl  social       workers.                                          To       further                    en-                                      grant,             made              possible                by      the       Roerig                  division                     of the              U.S.
courage        collal)oration                                               l)et\veen                      the
                                                                                                                                                    Pharmaceuticals                                Group,                    Pfizer,           Inc.
di 5Ci1)li iies                    ,         an            ongoing                         seninar
would             l)C optinial.                            In a(ldition,                         we l)e-                                               For an application                                       form               or additional information,
lieve           that             the         occasional                          case          c’oiifer-                                            write Achievement                                        Awards,               APA, 1400 K Street,     NW,
ences                could                   I)e          strengthened                                by          a                                 Washington,                           D.C.          20005,                or phone                  202-682-6173.
fl)C              regular,                         structured                          fbniiat                in
which             trainees                     could                present                ongoing

1552                                                                                                                                                                                                                     December
                                                                                                                                                                                                 PSYCHIATRIC SERVICES #{149}                                                                  1997              Vol.         48       No.        12

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