DRAFT

Canadian Association for Spiritual Care/Association canadienne de soins spirituels1

Scope of Practice for Spiritual Care and Counselling Specialists

October 2013

Introduction

A profession’s scope of practice encompasses the activities its practitioners are educated and authorized to perform. The overall scope of practice for the profession sets the outer limits of practice for all practitioners. The actual scope of practice of individual practitioners is influenced by the settings in which they practice, the requirements of the employer and the needs of their patients or clients.

For any given profession there are some procedures, actions, and processes that overlap with the activities of others. For example, firefighters extinguish blazes as part of their scope of practice. They receive extensive training and employ specilized equipment and techniques which qualify them to fight fires. Fires take place in different contexts – houses, forests, warehouses filled with chemicals, etc. Each fire poses unique challenges and the appropriate application of skill and technique can only be learned through experience. Not all flames, though, require a trained firefighter. For example, even a six-year-old can blow out a candle on a birthday cake.

Spiritual care, like fire-fighting, can be more or less complex depending on the variables in play. The more complex the situation, the more skilled the practitioner needs to be in order to ensure public safety. No scope of practice statement can cover all situations or all factors. This document speaks to and about the nation’s leaders in this field, the members of the Canadian Asscoiation for Spiritual Care/Association canadienne de soins spiritueles (CASC/ACSS).

At the same time, this scope of practice statement has implications for others who practice spiritual care, especially in the public arena. Its standards and processes need to function as the base from which governing bodies prepare standards of practice, educational institutions prepare curricula, and employers prepare job descriptions.

1 The CASC/ACSS mission is to promote excellence in spiritual care and counselling practice, education and research.

Consumers, too, need at least a general understanding of scope of practice to know who is qualified to provide different kinds of services. Key to this differentiation of services and providers is the distinction between religios care and spiritual care.2

The specific competencies of CASC/ACSS3 are based upon the standards established by the Spiritual Care Collaborative, an international group whose members cover the full theological, religious and spiritual spectrum. Any agency or institution which fails to honour the normative nature of a scope of practice such as this one will be exposing itself to significant risk by allowing for the unsafe practice of spiritual care and counselling.

Spirituality, like fire, can be of great benefit but is harmful if not handled properly. Just as throwing water on a grease fire will make a bad siuation worse, relying on poorly understood generalized approaches will result in damage to vulnerable people. Agencies and institutions need to provide their staff, physicians and volunteers with training in screening for spiritual distress in its various manifestations4. Only then will there be a reasonable level of confidence that appropriate referrals for thorough assessment and skilled application of interventions will produce quality and timely spiritual care and counsel.

Spiritual Care and Counselling Specialists

CASC/ACSS Spiritual Care and Counselling Specialists (SCCS) are clinical practitioners who help people draw upon their existing and chosen spiritual, religious and cultural resources for direction, strength, wisdom and healing as they journey through life’s stages.. They are educated at master’s and doctoral levels and have a minimum of 2,500 hours in post graduate clinical training in order to qualify for certification as professionals who are competent to integrate the development of clinical skills with knowledge of self and knowledge of theological, spiritual, philosophical, psychological and cultural frameworks.

Scope of Practice Statement 5

Spiritual Care and Counselling Specialists seek to improve the quality of life for individuals and groups experiencing spiritual, moral and existential distress related to changes in health, maturation, ability, and life circumstances. They utilize a holistic, relational approach to assess the nature and extent of the concerns; collaboratively develop a plan of care; provide therapeutic interventions to promote, maintain, and restore health and/or palliate illness and injury; and evaluate the implementation of the plan of care to ensure its efficacy and adequacy.

2 See Appendix A for a more complete explanation of this distinction3 See Appendix B for the complete listing of the validated core competencies.4 See Appendix C for examples of how spiritual needs can manifest.5 The full scope of practice as stated in this document applied to members of CASC/ACSS who are certifed Spiritual Care and Counselling Specialists. Other members of the organization have restricted and limited scopes of practice as shown in Appendix D.

2

Context of Care 6

Spirituality in the early 21st century may at times appear to be dominated and caught between two extremes. We have on the one side those convinced of and hoping to celebrate a modern secularism where the old dogmas of religion will no longer oppress the rational thinkers of the day who are lifting away centuries of superstition. On the other, there are some strongly lamenting the drift from religion to raw materialism, who mourn the break up of family, society and morality, and urge their neighbours to return to God and adhere to the sacred texts of old as the only sure way forward. Most people, however, are at neither of these extremes.

Research and surveys show several things happening at once in the Western world7. There is a decline in regular church going yet an increase in peoples’ willingness to talk about spiritual things There is a new confidence in the rights of small faith and belief communities and other minority groups to ‘be themselves’ and to expect to be treated as respectfully as other larger and longer established groups. There is also a growing acceptance of humanistic philosophy and values, witnessed by the increasing number of secular weddings and funerals – which again is balanced by increased interest in traditional spiritual exercises such as yoga and meditation, or spirituality of a broad and less definable type.Many find themselves between the religious certainties of a bygone age and the cold rationality of the opposite extreme. They have values and beliefs but they do not find it easy to say exactly where they belong.

Purpose and Role of Spiritual Care

The purpose of spiritual care and counselling is to support others by focusing primarily although not exclusively, on their spiritual practices. This support fosters healthy development in accordance with each one’s unique worldview and significant concerns. It assists in finding contextual and ultimate meaning in life. Spiritual care is provided in a variety of institutional settings including health care, military, corrections, education and other multi-faith, religious and secular communities as well as private practice settings. In most institutions the role of a spiritual care practitioner includes supportive, caring staff/colleague consultation in addition to client8 care.

Effective spiritual care has therapeutic outcomes insofar as its goal is for spiritual health and wholeness. Spiritual Care and Counselling Specialists may or may not provide therapy9 defined as facilitating cures or solutions to pathologies. Spiritual care seeks to promote spiritual well-being in the midst of the human condition with all of its 6 This section is taken from Spiritual Care Matters An Introductory Resource for all NHS Scotland Staff7 Hay D (2001) The Spirituality of Adults in Britain. Extracts of a paper presented to the Spirituality in Health and Community Care conference at Stirling Management Centre, Scotland on 15-17th November 2001.8 Use of “client” defines persons including patients and/or family members, counselees, residents, inmates, congregants, spiritual directees, students or staff in keeping with the practitioner’s professional setting.9 “Therapy” comes from the Greek word therapeuein, denoting “to attend”, “to treat”, and “clinical” connotes at the bedside. Spiritual Care and Counselling Specialists do offer careful attending, i.e. therapy, whether or not offering clinical treatment in the narrower sense of the concept.

3

challenges, crises, illness, suffering, pain and grief. As a result of effective spiritual care interventions, symptoms of spiritual distress and suffering may be transcended, transformed or alleviated and healing is facilitated. In addition, spiritual care is often provided at times of celebration and joy where there is no spiritual distress, as in the birth of a child or a wedding ceremony. Spiritual Care practitioners are a therapeutic presence. They witness experience and minister to others by providing sacred space and ritual in the ordinary and profound moments of life and death. This role fills a universal human need and has existed in various forms and nomenclature throughout history in all cultures. A spiritual care practitioner is understood symbolically as one who walks alongside others in times of joy or sorrow and stands between what is known and the mystery of the unknown.

Therapeutic Interventions and Functions

Relational Approach

SCCSs operate with a person/family-centered approach to assessment and care that sensitively encounters the other and engages them in their healing process. In addition to providing a context within which core beliefs, values and concerns can be shared, the SCCSs respectful acknowledgement of the other typically has an intrinsic therapeutic value by affirming their basic worth and dignity as a human being.

Spiritual Assessment10

SCCSs conduct assessments that evaluate the emotional and spiritual needs of persons who voluntarily seek care. Such assessments include identifying the care-seeker’s sources of spiritual strength, hope, coping methods, needs, risks and wellness goals by using communication strategies that include empathic listening and reflection i.e. that demonstrate authentic compassion and empathy. The assessment requires both a non-judgmental validation of the client’s emotional and spiritual experience and an appreciation of the client’s world view informed by historical, theological, philosophical, socio-cultural and psychological understandings of human development and transition.

Collaborative Care Planning

SCCSs seek to assist the client/family to identify and articulate personalized goals and objectives that not only are appropriate to the situation but complement and are integrated with the inter-professional care plan. The SCCS ensures planned interventions are based on an informed therapeutic approach, realistically match available resources, and are delivered in a timely fashion.

Spiritually Focused Support

10 Such assessments are complex and require high order analytical skills, advanced relational competence, and excellent awareness of communication techniques; therefore they are undertaken responsibly only by certified SCCSs or advanced trainees under supervision.

4

SCCSs assist persons to access resources such as those found in the wisdom of the care-seeker’s own spiritual tradition in order to foster hope and inner strength. SCCSs facilitate the person’s exploration of the role and function of their spiritual/religious identity; find a sense of meaning or purpose in life; and foster experiences of relational connection and community. SCCSs provide or facilitate prayers, rituals, instruction, ceremonies, sacred texts, directed meditation, etc. in service of the other’s authentic, creative and responsible expressions of spirituality.

Spiritually Focused Therapy

SCCSs may operate with a scope of practice which allows them to use a variety of therapeutic interventions which may have their origins in other social sciences or helping professions. Such techniques are offered when there is a reasonable belief that they are consistent with, and supportive of, the client’s own belief system present at various levels of self awareness. SCCSs help clients/families explore the deeper meaning or interpretation they ascribe to their experience and may facilitate emotional expression related to the presenting issues. SCCSs utilize such techniques and approaches if they are within their (expanded) scope of practice or while under the direct supervision of a fully qualified practitioner/educator.

Administration and Leadership

SCCSs exhibit leadership that provides advocacy and support as an integrated member of the inter-professional care team. As part of the larger institution, SCCSs promote positive organizational values by participating in leadership opportunities, change management and system transformation in a manner that preserves and fosters both the spirituality and the humanization of the work place. SCCSs offer supportive consultation to both staff and management. They ensure religious volunteers, visitors and other professionals adhere to guidelines designed to protect vulnerable persons. They advocate for adequate material and human resources appropriate to the well being of persons seeking spiritual care.

Brokering Diversity

SCCSs are trained and assessed to ensure that they both provide culturally safe, appropriate care and facilitate respectful connection between persons of diverse cultures and beliefs. They provide care that takes into account culture, bias and the specific needs of the individual and community. SCCSs understand, value, promote and advocate for equitable care based on reasonable accommodation of cultural, spiritual and religious needs and practices. They help the inter-professional team to integrate knowledge of diversity with reference to age, class, race, gender, ethnicity, levels of ability, language, spiritual and religious beliefs, educational achievement, sexuality, social factors, family, health, beliefs and willingness to seek help in order to mitigate stigma, discrimination and oppression.

Collaboration and Partnerships

General

SCCSs are accountable to care-seekers/families, employers, fellow professionals, faith communities and the public at large in terms of their professional activities. They serve as translational bridges between science-based systems and professions and

5

people/communities founded on faith. SCCSs provide the former with current information on particular faith groups and cultural traditions. They provide the latter with explanations of theoretical concepts in everyday language so that knowledge transfer can flow freely back and forth to facilitate client involvement and investment in care plans and interventions.

Internal

SCCSs build and sustain strong working relationships with persons seeking care and others involved in providing that care. They understand and respect the role and function of each member of the inter-professional team and work to ensure that their role is also understood and respected by others. To that end SCCSs clearly define and communicate to other team members the meaning and methods of spiritual care, educate them on the criteria for referrals to spiritual care, and make appropriate referrals to other professionals.

External

SCCSs liaise with community faith group volunteers and leaders to support them in providing religious care to adherents of that particular faith who are in institutional care. SCCSs orient faith group volunteers and leaders to relevant policies and procedures of the institution to ensure that the religious care is given safely and without infringing on the rights of others.

SCCSs also participate in organizations geared towards professional development and/or the promotion and protection of spirituality in the public arena.

Documentation and Charting

SCCSs document clinical assessments, interventions and referrals consistent with the standards used by other members of the inter-professional team. They keep records and statistics in a timely manner to ensure others have access to information pertinent to care planning and discharge decisions. SCCSs ensure that all charting and documentation differentiates fact from opinion. They understand and employ confidentiality both out of respect for the person/family and to comply with relevant legislation. They secure and keep written and electronic records for an appropriately designated length of time.

Ethical Behaviour

SCCSs adhere to the values of the CASC/ACSS Code of Ethics and are committed to reflecting justice, compassion and healing for all. They participate in and promote ethical reasoning and moral development in individuals, institutions and communities. To that end, SCCSs often participate on clinical and professional ethics committees, when advisable. They articulate and maintain clear professional and therapeutic boundaries and make referrals or initiate consultations when appropriate.

6

Core Relational Values

The practice of spiritual care flows from underlying core values that shape the practitioner’s interactions. We specifically, although not exclusively, highlight the following:

Respect – we validate the worth and value of all people and respect their freedom of choice

Empathy – we listen attentively and deeply in an effort to understand another person’s circumstances, point of view, thoughts and feelings

Faith Affirmation – we encourage beliefs that bring hope, peace, and strength to foster coping skills and healing.

Connection – we understand the interconnectedness and interdependence of all existence and undertake to promote positive relationships

Vitality – we promote what inspires life-giving energy versus what is destructive, dispiriting or soul-destroying.

Core Practice Values

Competence – we are committed to adherence to the CASC/ACSS standards11 of practice

Ethical Conduct – we seek the highest good of all persons entrusted to our care

Self-care – we integrate personal spiritual practices with spiritual growth and professional development

Responsibility – we fulfill our professional responsibilities in keeping with the scope of practice outlined by hiring institutions, CASC/ACSS Standards of Practice, and faith affiliation guidelines

Accountability – we adhere to professional competence and performance reviews in keeping with the CASC/ACSS standards for certification and professional practice, institutional policies, and faith community policies and procedures

11 There is a direct correlation between competencies and standards. Competencies are those attributes and capacities necessary to care well. Standards are usually articulated by diverse professional organizations (such as CASC/ACSS) and governmental or religious institutions. They embody key values and vocational commitments; they also identify certain legally binding professional and ethical requirements. We understand competencies as those personal and professional qualities, assets or skills with which Spiritual Care and Counselling Specialists meet the standards of practice in a wide variety of care giving settings.

7

Appendix A

Differentiation between Spiritual Care and Religious Care

Spirituality is understood to be a common part of human life. It is experienced and expressed in many ways, sometimes religious and sometimes not. It is also understood that good spiritual care will contribute to overall health, wellness, and meaning in life.

Spiritual Care and Counselling Specialists (SCCS) all appreciate the diversity of spiritualities in our world. Some are trained to provide religious care to those of similar faith in settings like a hospital or congregation. Others provide spiritual care to a variety of clients of diverse faiths, worldviews or religions in settings such as the counselling centre, private practice, the hospital, the mental health program, college/university, the military or the prison. SCCSs enable those they serve to access their spiritual resources, to work through spiritual problems, to persevere through crises and tragedies and to face the future with hope.

“Spiritual” points to common human dimensions of meaning-making and significance such as value/purpose, faith, hope, and love. Essentially, these dimensions are life-giving to the spirit of a person and are universal.

“Religious” points to the world’s religions and describes in formation, practice and leadership, both doctrine and rites.

The assumption is that spirituality is a common human dimension that may or may not be expressed through defined religious practice; therefore, spirituality and religion are not mutually exclusive. Spiritual Care is built upon and embraces Religious Care where the client’s personal spiritual expression warrants inclusion of a particular religious belief system.

The key difference between Spiritual Care providers and Religious Care providers is the scope of practice for diversity. Spiritual Care encompasses the varied belief systems and worldviews of the client, crossing or transcending religious boundaries. Religious Care providers will offer care from their own faith perspective to meet the religious care requirements of the client.

8

Appendix B

Competencies for Spiritual Care and Counselling Specialist

1. Spiritual Assessment and Care

Spiritual Assessment and Care are distinct but inter-related activities. Spiritual Assessment is an extensive, in-depth, ongoing process of actively listening to and summarizing a client’s story, spiritual strengths, needs, hopes and coping strategies as they emerge over time. Spiritual Care is the professional relationship established with a client that provides a framework for ongoing assessment and inter-professional interventions that help meet the wellness needs and goals of the client.12

1.1 Relational Approach: Provides a relational and patient/family-centred approach to assessment and care that sensitively encounters the client(s) and engages them in their healing process.

1.1.1. Engages with the client’s experience.1.1.2. Facilitates expression and articulation of a client’s beliefs, values, needs

and desires that shape the client’s choices and interactions.1.1.3. Encourages the client to express emotions and a full range of feelings.1.1.4. Encourages the client to share fears/concerns, hopes/dreams, creative

expression, intuition and awareness of relationships, including the divine/transcendent in understanding the core identity of the client.

1.2 Assessment: Gains an understanding of a client’s source(s) of spiritual strength, hope, methods/ways of coping, needs, risks and wellness goals through encountering the client and integrating this knowledge with historical, theological, philosophical, socio-cultural and psychological theoretical frameworks of human development and transitions in life.

1.2.1 Assesses by means of listening to story. Encounters the life narrative of the client through dialogue, observation and emotional understanding.

1.2.2 Identifies the client’s worldview and theological or spiritual belief system.1.2.3 Identifies the client’s sacred symbols, metaphors and relationships that provide meaning.1.2.4 Assesses past and present trauma, spiritual distress, spiritual pain,

suffering, grief and loss.1.2.5 Assesses specific risks, including suicide, homicide, violence, abuse,

neglect, drug abuse and monitors risk over time.1.2.6 Assesses spiritual coping strategies.1.2.7 Assesses for faith process and development, structure and content. 1.2.8 Recognizes when and how medications/drugs are impacting the client.

12 Adapted from: Christina M. Puchalski, B. Ferrell, Making Health Care Whole: Integrating Spirituality Into Health Care (Pennsylvania: Templeton Press, 2010), 95.

9

1.2.9 Recognizes when physiological or psychological symptoms are limiting effectiveness of care and when there is need for consultation with

otherswithin the care team.

1.3 Planning: Co-develops with the client(s) a spiritual care plan that complements and is integrated with inter-professional care plan, treatment and interventions.

1.3.1 Determines the type and level of care/intervention appropriate and formulates a therapeutic direction(s).

1.3.2 Attends to client’s expectations and the involvement of loved ones in the care plan.

` 1.3.3 Develops a safety plan.1.3.4 Develops personalized goals and objectives where relevant and

appropriate to the client situation.1.3.5 Ensures interventions are timely, based on informed therapeutic

approaches and are related to appropriate community resources.1.3.6 Monitors progress.1.3.7 Responds to disruptions of the spiritual care relationship in a timely

fashion.1.3.8 Monitors quality of the spiritual care relationship on an ongoing basis.1.3.9 Restores therapeutic direction when it is hindered or diminished.1.3.10 Integrates the practices of assessment, intervention and outcomes.1.3.11 Evaluates the therapeutic effectiveness of the Spiritual Care plan and

interventions.

1.4 Intervention: Provides a variety of interventions and approaches to spiritual care related to needs assessment and co-developed inter-professional care plans.

1.4.1 Helps client evaluate role and function of spiritual/religious identity in their life.

1.4.2 Helps client to identify spiritual strengths, vulnerabilities, resilience and resources.

1.4.3 Facilitates exploration of a client's sense of purpose and meaning in life.1.4.4 Facilitates exploration of issues in relationships, moral distress and

grief/loss.1.4.5 Facilitates contextualized meaning-making and sacred and religious

interpretation.1.4.6 Utilizes spiritual/theological/faith reflection in exploring and making

meaning of one’s life situation and in bringing the unconscious to the conscious understanding when it is safe and appropriate.

1.4.7 Fosters the client’s independence and responsibility within the care team.1.4.8 Offers support and guidance for spiritual growth.1.4.9 Strengthens relational connections and fosters experiences of community.1.4.10 Enables reconciliation (e.g. conflict management, forgiveness and

relational growth).

10

1.4.11 Assists client in their own creative expression of spirituality.1.4.12 Provides or facilitates prayer, rituals, rites, ceremonies and services.1.4.13 Leads or facilitates spiritually-focused themed groups, workshops and

studies.

2. Self-awareness

Assesses the impact of one’s own spirituality, beliefs, values, assumptions and power dynamics in relationships with clients.

2.1 Has a clear sense of personal and professional identity, integrity and authority.

2.2 Integrates personal culture, beliefs and values leading to authenticity, consistency and dependability in the practice of spiritual care.

2.3 Maintains the practice of self-reflection and self-evaluation includingcritical self reflection on one’s words, actions and theoretical orientation.

2.4 Recognizes professional limits, and when to make referrals and consultations.

2.5 Recognizes instances where practitioner’s life experiences may enhance therapeutic effectiveness.

2.6 Recognizes the symbolic power associated with the practitioner’s role andthe presence and importance of transference or counter transference in the spiritual care relationship.

2.7 Recognizes occupational hazards contributing to burnout.2.8 Integrates beliefs about well-being and distress.

3. Spiritual and Personal Development

Continues to develop and maintain personal and professional growth, awareness and self-understanding and makes oneself appropriately accountable.

3.1 Engages in ongoing theological/spiritual reflection.3.2 Nurtures and utilizes own spirituality with integrity.3.3 Identifies and integrates areas of need and interest regarding continuing

education in development of areas of own personhood, religion, spirituality and meaning.

3.4 Identifies and utilizes personal and professional support, consultation and supervision.

3.5 Evaluates clinical practice, identifies strengths and weaknesses, set goalsand modifies practice accordingly as necessary.

3.6 Consults with other professionals and spiritual care and counselling colleagues when appropriate.

3.7 Engages regularly and holistically (body, mind, spirit) in self-caring practices.

11

4. Multi-Dimensional Communication

Employs communication strategies that include active and attentive listening, awareness of the non-verbal, appropriateness, and relevant content.

4.1 Listens actively, empathically and reflectively, validating the client’s emotional and spiritual experience.

4.2 Assesses and responds appropriately to all aspects of non-verbal communication.

4.3 Attends to social support and relationships.4.4 Attends and respectfully responds to intercultural relational approaches.4.5 Artfully responds to richness of the client out of the richness of one’s own

personhood.4.6 Communicates in a manner appropriate to the recipient.4.7 Attends to feelings, attitudes, thoughts and behaviour.4.8 Employs effective verbal (and non-verbal) communication.4.9 Explains theoretical concepts in everyday language.4.10 Recognizes conflict, whether overt or covert, verbal or non-verbal and

uses a conflict resolution approach appropriate to the situation.4.11 Communicates assessment information so the client understands its

relationship to care giving goals and outcomes.

5. Documentation and Charting

Documents clinical assessments, interventions and referrals in a way that is understood by members of the inter-professional team. Keeps records and statistics in a timely manner; demonstrates clarity, skill and appropriate confidentiality in all paper/electronic correspondence.

5.1 Identifies the referral source and reason for initial assessment.5.2 Differentiates fact from opinion.5.3 Uses clear and concise language that respects whole person care.5.4 Provides concise statements about the significance of appearance, voice5.5 quality, and/or non-verbal communication in clinical interactions.5.6 Notes referral and/or follow-up plan.5.7 Understands and employs confidentiality limits regarding stories and

confessions.5.8 Employs electronic communication as relevant to practice and maintains

appropriate security in its use.5.9 Maintains professional documentation on clients in a secure location and5.10 keeps records for an appropriately designated length of time.

12

6. Brokering Diversity

Understands, values, promotes diversity and inclusion, and advocates for equitable care. Provides care that takes into account culture, bias, and the specific needs of clients.

6.1 Assesses the dynamics of the culture, resources and community.6.2 Values diversity and advocates for accommodation of cultural, spiritual

and religious needs and practices.6.3 Assumes and communicates a non-judgmental stance.6.4 Demonstrates sensitivity to the diversity and setting of spiritual care.6.5 Integrates knowledge of diversity with reference to age, class, race,

gender, ethnicity, levels of ability, language, spiritual and religious beliefs,educational achievement, sexuality, social factors, family, health beliefsand willingness to seek help.

6.6 Adapts the care approach when working with diverse individuals, families and groups and respectfully asks for guidance in learning interculturalrelationship skills.

6.7 Shows respect toward various disciplines and interest groups.6.8 Models behaviour that promotes inclusion.6.9 Recognizes and responds to how oppression may impact human

functioning.6.10 Recognizes how the spiritual care practitioner’s values and biases may

affect relationships with diverse clients.6.11 Identifies culturally and spiritually relevant resources.6.12 Explores and addresses in a timely manner differences that may lead to

misunderstanding and conflict.6.13 Provides current information on different faith groups and cultural

traditions.

7. Ethical Behaviour

Ethical behaviour is congruent with the values of the CASC/ACSS Code of Ethics reflecting justice, compassion and healing for all.

7.1 Shows respect to others.7.2 Protects confidentiality.7.3 Articulates and maintains clear, appropriate and therapeutic boundaries.7.4 Recognizes one’s responsibility to report to authorities what is in the

interest of security and/or required by law and/or the CASC/ACSS code of ethics.

7.5 Participates in and promotes ethical reasoning and moral development.7.6 Works within one’s scope of practice knowing when it may be appropriate

to make a referral or initiate a consultation.7.7 Identifies ethical issues encountered in one’s practice, teaching and

13

research.7.8 Complies with relevant regulations at all levels of government and within

one’s provincial regulatory body.7.9 Differentiates the roles and functions of professional associations relevant

to one’s practice.7.10 Advocates for individuals in abuse or neglect situations.7.11 Speaks out against systemic oppressions that are in violation of human

dignity, human rights and/or the CASC/ACSS code of ethics.

8. Collaboration and Partnerships

Is accountable to the public, faith communities, employers and professionals in all professional relationships.13

8.1 Builds and sustains working relationships with members of inter-professional, multi-disciplinary and multi-faith groups.

8.2 Clearly understands the role and function of each member of the inter-professional group and/or service providers working with the client.

8.3 Educates clients and professional colleagues on the criteria for referral for spiritual care and counselling services.

8.4 Clearly defines and communicates to other team members the meaning and methods of spiritual care.

8.5 Makes appropriate referrals to other professionals and partners.

9. Leadership

Exhibits leadership that provides advocacy and support as an integral team member.

9.1 Provides support to both staff and management.9.2 Provides Clinical and Professional Consultation.9.3 Ensures a sacred space for prayer, ritual and meditation.9.4 Develops a strategic plan, which not only supports and advocates for

spiritual care in the work place, but promotes the soul of the organizationand also strengthens the organization’s values in a manner that works towards preserving and fostering both the spirituality and the humanizationof the work place.

9.5 Participates in professional organizations.9.6 Establishes a way to involve volunteers appropriately.9.7 Participates in leadership opportunities, change management and

systems transformation and provides leadership to organizational projectsrelevant to spiritual values as appropriate.

9.8 Acts as a change agent within the culture of the organization.9.9 Prioritizes and organizes activities, using planning and management skills,

to support spiritual care strategies.

13 See Interprofessional Collaborative Competencies found following Section 10

14

9.10 Follows through on commitments in a timely manner.9.11 Obtains feedback from external sources to assist in performance review9.12 Appreciates and responsibly uses resources.9.13 Strategically positions spiritual care to ensure the well being of clients and

ensures adequate resources.9.14 Attends to union matters as required and/or appropriate.9.15 Provides education on an ongoing basis related to spiritual care and

counselling.

10. Research

Sees research as integral to professional functioning and in keeping with one’s area of expertise.

10.1 Reads research articles as continuing education pertinent to one’s area of practice.

10.2 Asks researchable questions as these arise from practice.10.3 Participates in and/or promotes research.10.4 Uses appropriate methodologies and established ethical protocols (if/when

conducting research).10.5 Subjects one’s findings as required and appropriate to professional peer10.6 review (if/when conducting research)10.7 Disseminates research information.

15

INTERPROFESSIONAL COLLABORATIVE COMPETENCIES14

Communication

Descriptor: Ability to communicate effectively in a respectful and responsive manner with others.

1. Communicates and expresses ideas in an assertive and respectful manner.2. Uses communication strategies (e.g. oral, written, information technology) in an

effective manner with others.

Collaboration

Descriptor: Ability to establish/maintain collaborative working relationships with other providers, patients/clients and families.

1. Establishes collaborative relationships with others in planning and providing patient/client care.

2. Promotes the integration of information and perspectives from others in planning and providing care for patients/clients.

3. Upon approval of the patient/client or designated decision-maker, ensures that appropriate information is shared with other providers.

Roles and Responsibilities

Descriptor: Ability to explain one’s own roles and responsibilities related to patient/client and family care (e.g. scope of practice, legal and ethical responsibilities); and to demonstrate an understanding of the roles, responsibilities and relationships of others within the team.

1. Describes one’s own roles and responsibilities in a clear manner.2. Describes the roles and responsibilities of other providers.3. Shares evidence-based and/or best practice knowledge with others.4. Integrates the roles and responsibilities of others with one’s own to optimize

patient/client care.5. Accepts accountability for one’s contributions.

14 Developed through: Development and Evaluation of an Assessment Rubric for Measuring Interprofessional Collaborative Competencies, funded by the Academic Health Council –Champlain Region Principal Investigator: Dr. Vernon Curran, PhD, Director of Research and Development, Professional Development and Conferencing Services, Faculty of Medicine, Memorial University; Co-investigators: Dr. Pippa Hall, Dr. Lynn Casimiro, Dr. Ivy Oandasan, Manon Tremblay, Kelly Lackie, Valerie Banfield, Susan Wagner, Dr. Brian Simmons

16

Appendix C

Ameliorable Conditions15,16

Emotional Conditions

Spiritual Care and Counselling Specialists (SCCS) involvement is recommended for a person in whom the stress of physical or mental illness, trauma, loss, or situational hardship (e.g. incarceration) has resulted in a diminished capacity to cope. This may be due to, or result in, impaired access to their internal resources such as hope, acceptance, trust and the will to live. Common manifestations of this condition are existential angst, guilt (false or real), anxiety, depression and the presence of other forms of emotional suffering/spiritual malaise.

Cognitive Conditions

SCCS involvement is recommended when a person expresses difficulty in making sense or meaning while utilizing their religious or philosophical framework and, as a result, experiences a thought-related disorder such as cognitive dissonance, idée fixe, perseveration or rigid thinking.

Relational Conditions

SCCS involvement is recommended when people experience ruptures in communication or estrangement between themselves and significant others or experience enforced periods of isolation. SCCSs may be particularly and uniquely helpful when the presenting issue is related to existential/spiritual issues (e.g. an inability to discuss death and dying) or involves strong feelings of offence, guilt and/or shame.

Psychological/Psychiatric Conditions

SCCS involvement is recommended for a person in whom there is a diminished capacity to work with nuanced distinctions between reality and delusion, truth and belief, and faith and facts. A person having such a crisis of belief may manifest with religious delusions or cognitive conditions which exacerbate symptomatology, increase their experience of suffering, and/or impede treatment.

Substance Abuse/Addiction

SCCS involvement is recommended for a person whose use of substances or bahaviours has created conditions which interfere with their own and/or others quality of life. SCCSs may be particularly helpful when people are starting to look at emotional

15 Note: These categories indicate conditions in which SCCS involvement has been shown to produce benefits or lessen distress; however, there is no implied guarantee of efficacy in every case. 16 Note: Persons do not enter publically-funded care or custody because of a spiritual diagnosis. Spiritual Health Providers therefore do not claim to treat directly any medically diagnosed disease or disorder. They address spiritual conditions of persons in care or custody in a manner that research, evidence and anecdote show supports physical, mental and/or social health and, thereby, improves the person’s quality of life.

17

triggers and other reasons which predicate their actions (motivational Interviewing); when people are seeking to (re)establish spiritual connections and practices which support their aspirations for change; and when people are dealing with issues of guilt, shame, and hope related to times of relapse during the recovery process.

Situational Conditions

SCCS involvement is recommended for a person who experiences spiritual, moral or existential distress due to a crisis related to a trauma directly or indirectly experienced. Such traumas could include witnessing the death of a loved one, having a miscarriage, being incarcerated, or any similar event which is experienced by the person as a specific assault on their sense of security based on their view of how life is or ought to be,

Compliance/Cooperation

SCCS involvement is recommended for a person who is non-adherent with or refusing treatment, especially if the person is appealing to cultural beliefs, entrenched personal values or religious practices as the basis or justification for their behaviour.

18

Appendix D

Scope of Practice for CASC/ACSS Members Defined by Category

Category 1 – Restricted Practice17

Who is in this categoryat is an ASSOCIATE MEMBER, SPIRITUAL CARE? Anyone who is recognized by and accountable to the institution or agency to offer spiritual care as part of their position description. Such persons may be employed by the institution, but more commonly are volunteers, students and/or employed by an external group/agency such as a religious denomination.

The Role of a person in this categoryn ASSOCIATE MEMBER, SPIRITUAL CARE: To practice active listening, to provide information and resources, to make appropriate referrals, and to assist with programs and interventions under the direction of a certified Spiritual Care and Counselling Specialist.

Education/Professional Qualification: No minimum standards for this role.

Specialized knowledge: The person in this categoryAssociate Member has minimal specialized knowledge and expertise in the delivery of spiritual care, but practices a caring presence in order to offer support and encouragement.

Accountability/Supervision: Requires direct and close supervision by someone with cetified competency for all roles/tasks except for those identified in the following chart.Associate Member

Category 2 – Limited Practice

Who is in this categoryat is an ASSOCIATE MEMBER, SPIRITUAL CARE? Anyone who is recognized by and accountable to the institution to offer spiritual care as part of their position description. Although such persons may be volunteers, students and/or employed by an external group/agency such as a religious denomination, they are most commonly employed by the institution or agency.

The Role of a person in this categoryn ASSOCIATE MEMBER, SPIRITUAL CARE: To provide professional spiritual care services including a caring presence and sensitivity to the unique spiritual and religious needs of the clients served. Functions at a Scope of Practice appropriate to their level of training and proficiency, including making the appropriate referrals when the spiritual needs identified are beyond their capacities.

17 The restrictions in this category are the appropriate boundaries to establish and apply to all people who are not members of CASC/ACSS who offer spiritual care in a publically funded agency or institution.

19

Education/Professional Qualification: At least one year of graduate studies (Master’s level) in religious, spiritual or theological studies. At least one unit of Supervised Pastoral Education at an Advanced Level (ordinarily requires a minimum of 1200 hours of clinical training) .

Specialized knowledge: The person in this categoryAssociate Member has developing specialized knowledge and expertise in the delivery of spiritual care with specific client groups.

Accountability/Supervision: May function as a member of an interdisciplinary care team. Requires supervision and suppport for all roles/tasks by a certified Spiritual Care and Counselling Specialist proportional to the complexity of the care required Associate Memberby specific clients.

Category 3 – Full Scope of Practice

Who is in this categoryat is an ASSOCIATE MEMBER, SPIRITUAL CARE? Anyone who is recognized by and accountable to the institution to offer spiritual care as part of their position description. Such persons are almost always employed by the institution or agency in which they work.

The Role of a person in this categoryn ASSOCIATE MEMBER, SPIRITUAL CARE: To provide professional spiritual care services including a caring presence and sensitivity to the unique spiritual and religious needs of the clients served. Functions at a Scope of Practice appropriate to their level of training and proficiency, including making the appropriate referrals when the spiritual needs identified are beyond their capacities.

Education/Professional Qualification: At least two years years of graduate studies (Master’s level) in religious, spiritual or theological studies, including at least one course in Ethics. At least two units of Supervised Pastoral Education at an Advanced Level (ordinarily requires a minimum of 1600 hours of clinical training). At least 1000 hours of clinical experience while receiving mentorship and support from a certified Spiritual Care and Counselling Specialist. .

Specialized knowledge: The person in this categoryAssociate Member has consistent and proficient specialized knowledge and expertise in the delivery of spiritual care applicable to a variety of clients.

Accountability/Supervision: Typically functions as a member of an interdisciplinary care team. Does not require supervision and suppport for roles/tasks ordinarily, but remains accountable to peers through a regular review process.Associate Member

20

.

Required or Expected Level of Proficiency18

Competency Category 1 - Restricted

Category 2 -Limited

Category 3 – Full Scope

Relational Approach 1-3 2-4 4-6

Assessment and Referral Referrals only 2-4 4-6

Planning n/a 2-4 4-6

Intervention as directed under close supervision

2-4 4-6

Self-awareness 1-3 2-4 4-6

Spiritual and Personal Development 1-3 2-4 4-6

Multi-dimensional Communication 1-3 2-4 4-6

Documentation and Charting n/a 2-4 4-6

Brokering Diversity 1-3 2-4 4-6

Ethical Behaviour 2-3 2-4 4-6

Collaboration and Partnership 1-2 2-4 4-6

Leadership 1-2 2-4 4-6

Research n/a 2-4 4-6

Interprofessional Collaboration 1-2 2-4 4-6

Number of times assessed by certified SCCS 0-3 3-4 6

18 See Appendix E for definition for numerical rating scale used in this chart

21

Appendix E

Competency Assessment Scale

The competency proficiency of the Spiritual Care and Counselling Specialists (SCCS) required will vary depending on the institutional role/scope of practice requirements. The competency proficiency will vary depending on the education, training, skill level and experience of the SCCS. The following chart indicates 6 levels for competency demonstration and assessment.

Rating Scale

N/A – Not Applicable

Competency is not expected or required within scope of practice

Level 1 – No Demonstrated Achievement

Competency not practiced

Level 2 – Beginning

Starting to engage opportunities to develop competency

Level 3 – Developing

Frequently demonstrates this competency in selected situations

Level 4 – Consistent

Continually demonstrates this competency within the defined role Fully meets expectations

Level 5 – Proficient

Models this competency for others to learn Performs at a high level in this competency Demonstrates a significant level of maturity in this competency

Level 6 – Mastery

Teaches/Mentors others in this competency Models at an advanced level Demonstrates this competency in a variety of contexts

22

23