History of Healthcare Chaplaincy and HCMA

Our Lord and Savior Jesus hath left us a commandment,
which concerns all Christians alike, —
that we should render the duties of humanity,
or (as the Scriptures call them) the works of mercy,
to such as are afflicted and under calamity;
that we should visit the sick,
endeavor to set free the prisoners,
and perform other like acts of kindness to our neighbor,
whereby the evils of this present time
may in some measure be lightened.

— Martin Luther (1483-1546), German monk, theologian

Definition

Webster’s Dictionary defines a Chaplain as: “a minister, priest, or rabbi serving in a religious capacity with the armed services, or in a prison, hospital, etc.”

Historical Background

Old Testament

In the Old Testament book of Joshua, Levite priests accompany the Israelites’ military and political expedition into Israel; carrying the Ark of the Covenant and playing a major role in the goodwill of military matters. While these priests cannot be considered “chaplains” with the current meaning, their role as spiritual aides provides a model for modern chaplains to rely upon.

Martin of Tours

The term chaplain comes from the fourth century legend of Martin of Tours. Martin was born to a pagan family about 316 A.D. in Pannonia, a Roman Province that included modern Hungary. When he grew up, he became a Roman soldier.

At approximately age 21, on a very cold winter day, Martin was passing by the gates of Amiens in Gaul (what is today France). He saw a man who was freezing by the side of the road. He was moved with compassion after seeing and hearing the pleas of the beggar being ignored by several others who had ridden by on their horses. He decided to help, though he had little himself. He took the one valuable possession he owned — his cape — and cut it in half with his sword. He kept half for himself and gave the other half to the beggar.

That night, as the story goes, Martin had a vision in which he came to understand that the beggar was Christ Himself. The vision shook Martin to the core. After that experience, he decided to follow the Christian faith and was baptized by Bishop St. Hillary. Ultimately, he left the army to devote himself to the church. He later became Bishop of Tours and founded a monastery in Eastern Europe.

After his death, the remaining half of the cape became a relic — an object of value as a religious reminder of his life and work. The cloak (Latin: cappa) was kept in a shrine and eventually the place took on the name of the cape. The French took the word into their language as chapele, from which comes the English word chapel.

During the Middle Ages, St. Martin’s cloak was carried into battle by the kings as a banner signifying the presence of God. But since it was a sacred relic of the church, a priest went along as custodian. This guardian of the cape, or capellanus (which became chapelain in Old French), also tended the king’s religious needs. This is where the word Chaplain comes from.

This story is more than a quaint bit of etymology explaining the origin of the terms “chaplain” and “chapel.” It gives a clue into the essential nature of the chaplaincy, as you know it today.

Historically, the Chaplain was a member of one institution — the church — serving another institution — the army. Definitions of the chaplaincy seldom take into account this institutional duality. Chaplains in the healthcare field are unique in that they are the only member of the medical team whose primary identification is with a non-medical institution. But they are also unique in the church as the only ministers who are professionally certified and endorsed to serve in a healthcare institution.

Domestic Chaplains

A domestic chaplain was a chaplain attached to a noble household in order to grant the family a degree of self-sufficiency in religion. The chaplain was freed from any obligation to reside in a particular place so he could travel with the family, internationally if necessary, and minister to their spiritual needs. Further, the family could appoint a chaplain who reflected their own doctrinal views. Domestic chaplains performed family christenings, funerals and weddings and were able to conduct services in the family’s private chapel, excusing the nobility from attending public worship.[1]

In feudal times most laymen, and for centuries even most noblemen, were poorly educated and the chaplain would also be an important source of scholarship in the household, tutoring children and providing counsel to the family on matters broader than religion.[2]

Before the advent of the legal profession, modern bureaucracy and civil service, the literate clergy were often employed as secretarial staff, as in a chancery. Hence the term clerk, derived from Latin clericus (clergyman). This made them very influential in temporal affairs. There was also a moral impact since they heard the confessions of the elite.

The domestic chaplain was an important part of the life of the peerage in England from the reign of Henry VIII to the middle of the nineteenth century. Up until 1840, Anglican domestic chaplains were regulated by law and enjoyed the substantial financial advantage of being able to purchase a license to hold two benefices simultaneously while residing in neither. [3]

Many historical monarchies and major noble houses had one (and as of 2008 still have one) and often had several domestic or private chaplains as part of their Ecclesiastical Household, either following them or attached to a castle or other residence. Castles with attached chaplains generally had at least one Chapel Royal, sometimes as significant as a cathedral. A modern example is St. George’s Chapel, Windsor Castle, and also the home of the Order of the Garter.

Military Chaplains

The first English military-oriented chaplains were priests on board proto-naval vessels during the eighth century A.D. Land based chaplains appeared during the reign of King Edward I, although their duties included jobs that today would come under the jurisdiction of military engineers and medical officers. A priest attached to a feudal noble household would follow his liege lord into battle. In 1796 the Parliament of Great Britain passed a Royal Warrant that established the Royal Army Chaplains’ Department in the British Army.

The current form of military chaplain dates from the era of World War I. A chaplain provides spiritual and pastoral support for service personnel, including the conduct of religious services at sea or in the field. In the Royal Navy chaplains are traditionally addressed by their Christian name, or with one of many nick-names (Bish; Sin-Bosun; Devil Dodger; Sky-Pilot; God Botherer etc). In the British Army and Royal Air Force, chaplains are traditionally referred to (and addressed) as padre.

In 1865, Abraham Lincoln signed legislation establishing the first national Homes for Disabled Volunteer Services. Chaplains were paid a salary of “$1500 per year and forage for one horse.” The Veterans Administration established chaplaincy services for all of their hospitals in 1945.

Corporate Chaplains

Some businesses, large and small, employ chaplains for their staff and/or clientele. According to The Economist (August 25, 2007, p. 64) there are 4,000 corporate chaplains in the US alone, with the majority being employees of specialist chaplaincy companies such as Marketplace Chaplains USA. According to the company, turnover at Taco Bell outlets in central Texas dropped by a third after they started employing chaplains.

Another organization supplying chaplains to corporations is Corporate Chaplains of America. CCA was founded in 1996 to provide genuine “Caring in the Workplace”, while following a structured business plan built upon process management principles. The organization employs full time, long term, career chaplains who combine workplace experience with professional chaplaincy training.

Various Chaplains

Chaplains also can be attached to sports teams, emergency services agencies, educational institutions, police and fire departments, private clubs, scout troops, ships, prisons, and nightclubs. The term can also refer to priests attached to Roman Catholic convents.

Healthcare Chaplains

In a healthcare facility, a Chaplain ministers primarily to the spiritual needs of patients/residents, family members, staff, and as an encourager to local Pastors. The Chaplain may serve as a volunteer or s/he may be an employee of the healthcare facility.

Development of Healthcare Chaplains

It is hard to find references to healthcare ministry in early churches. The early church fathers did not make any reference to healthcare ministry, even though all of them talked about the cure and care of the sick and suffering. Medical problems were taken care of in home-like alms houses, not scientific centers for technical work by physicians in highly administered situations.

Hospitals are a rather modern innovation.
•In 1872 there were only 178 hospitals in the United States.
•By 1910 there were more than 4,000 hospitals in the USA.
•In 1989 there were more than 6,800 hospitals in the USA.
•By 1995 there were 6,467 hospitals in the USA.
•In 2007 there were 6,245 hospitals listed in the USA Hospital Directory.

Prior to World War II, the community hospital was known as the quiet place on the hill. It was staffed with dedicated people, relatively underpaid, who fulfilled their responsibilities admirably, and they were held in high regard by the community. They had no ICU, no CCU, no dialysis unit, no open-heart surgery, no nuclear medicine, and not much of a laboratory. They did have a lot of personal care and most had chronic financial problems. Patients, who could afford to, ended up paying more than the cost of their care so that care could be provided for all.

In 1946, the Hospital Survey and Construction Act changed the picture of medical care. Tax rates were high, and without the cost of war, congress looked for ways to direct surplus revenues. One area was hospital construction. They enacted a huge subsidy program to encourage hospital construction. Scarcely a hospital was built in the 1950’s or 1960’s that did not receive a Hill-Burton grant and/or a low interest government loan. Twelve billion dollars were spent on hospital construction between 1946 and 1973. There were 403,000 beds added, which doubled our nation’s hospital bed capacity. More services were added: Physicians, Therapists, RNs, Lab Techs, Radiology Specialists, RT, OT, etc. More technology was added. From hospital construction, congress turned to scientific medical research. Federal expenditure for research expanded from $73 million in 1950 to $2 billion in 1972. These funds brought a technical revolution in medical care. Personnel to run the equipment increased the cost of care. Title XVII (Medicare) and Title XIX (Medicaid) were incorporated into the Social Security Act of 1965. It was all expensive. Medicare/Medicaid expenditures rose from $5 billion in 1967, to $33 billion in 1976, to $57.3 billion in 1985, and it was $602 billion in 2004.

Public pressure for quality care without high cost increased. Rather than focusing on expansion in the mid 1970’s, there began to be an emphasis on curtailing costs. The Secretary of Health Education and Welfare charged that “hospitals were obese,” with an excess of 200,000 beds and costs escalating at an annual rate of 14%. Encouraged to make medical services available to the poor, the hospitals now faced a cap on Medicaid and Medicare reimbursements. Insurance companies began to make changes in their reimbursement policies. Vast changes took place and the operation of hospitals and provision of healthcare services were still in a state of change in 1996, when this article was first written.

As mentioned earlier, the number of hospitals decreased from over 6,800 in 1989, to 6,467 in 1995, and 5,810 in 2002. The number increased to 7,569 in 2005 according to the U.S. Census Bureau. Of these hospitals, between 54 percent and 64 percent had chaplaincy services between 1980 and 2003. Smaller hospitals and those in rural areas are less likely to have chaplaincy services. Church-operated hospitals are much more likely to have chaplaincy services.[4]

CPE History

How did healthcare chaplaincy develop during these years? In 1925 the Clinical Pastoral Education (CPE) program began on the east coast in Massachusetts. In 1939 the Healthcare Chaplains Ministry Association began on the west coast in California.

CPE began in a state mental hospital in Worcester, Massachusetts. It was started due mainly to dissatisfaction with the traditional theological education of the day, which was considered by many to be too abstract, too removed from life, and too divorced from the practical tasks of ministry. It was an effort to get theological students out of the classrooms and into the wards and clinics of the suffering.

Five years earlier (1920), Rev. Anton T. Boisen, a Congregational minister, experienced a psychotic break. While a patient at Worcester State Hospital, Boisen discovered that the least helpful to him were visits from well-meaning but nevertheless ineffective minister friends. During one of his delusional episodes, Boisen believed he had “broken an opening in the wall which separated religion and medicine.”[5] He interpreted another delusion as a “plan of cooperation between the medical and religious workers.”[6]

Boisen eventually (1922-23) became a student of Dr. Richard Clarke Cabot, who is known as the physician who developed the case study method as a teaching instrument.[7]

In 1924-25, Boisen was serving as a Chaplain at Worcester State Hospital. He was sent several theological students by Dr. Cabot so they could learn something about mental illness. The intent was to get “clinical experience” outside of the classroom, to practice theology where it was most needed — in personal contact with individuals in trouble. Boisen later referred to these students in clinical areas as studying “living human documents.”

On the occasion of the movement’s 25th anniversary in 1950, Anton Boisen said:

This movement has no new gospel to proclaim. We are not seeking to introduce anything into the theological curriculum beyond a new approach to some ancient problems. We are trying, rather, to call attention back to the central task of the Church, that of saving souls, and to the central problem of theology, that of sin and salvation. What is new is the attempt to begin with the study of the living human documents rather than with books, and to focus attention upon those who are grappling desperately with the issues of spiritual life and death.

The decades of the 1930s and 1940s were increasingly a time of growth of the clinical pastoral education movement. Boisen and others in the CPE movement attempted “to stimulate pastors to explore their own inner world in order to become more sensitive companions to others’ struggles with the vital issues of life.” They tried to link “the external and internal world of the learner, the cognitive with the emotive, theory with practice, theology and psychology.”

The Council for Clinical Training of Theological Students was incorporated January 21, 1930. It originated from Boisen’s work and focused primarily on psychiatric and pastoral care. There were 16 students in 1930, which grew to 40 two years later. Additional hospitals, child guidance centers, and one prison were being utilized as training sites.

By 1954, there were nearly 30 “chaplain supervisors” certified by the Council, mostly in centers in the eastern United States. Relationships with theological seminaries developed as Clinical Pastoral Training (CPT), which became increasingly recognized by some denominations and seminaries as a required part of the theological training of clergy.

The Council united with the Institute of Pastoral Care, which originated under Dr. Cabot and focused primarily on pastoral care of the physically ill, to form the Association for Clinical Pastoral Education in 1967. This brought together several hundred chaplain supervisors and over five hundred centers offering what is now called Clinical Pastoral Education (CPE). The ACPE has developed standards to maintain the quality of CPE programs, curriculum, certification of pastoral educators (supervisors), and the accreditation of centers meeting those standards. Since 1969 it has been on the Federal Government’s Department of Education’s Commissioner’s list of nationally recognized accrediting agencies/associations in the field of clinical pastoral education.

Many Pastors have been trained through CPE and have ministered to individuals and their families in healthcare facilities throughout the United States. CPE has grown to include over 3,300 members that make up the ACPE, with some 350 ACPE Accredited CPE Centers, and about 600 ACPE certified faculty members (called CPE Supervisors). There are about 118 theological schools as members, and 21 faith groups and agencies who are partners with the ACPE.

The American College of Chaplains was one of the most well known professional chaplaincy agencies in the United States, supervising the training and certification of individuals for full-time ministry as Chaplains. In 1998 the College of Chaplains and the Association of Mental Health clergy merged to become the Association of Professional Chaplains (APC). They are an interfaith professional chaplaincy organization, endorsed by faith groups to serve persons in physical, spiritual, or mental need in diverse settings throughout the world.

Unfortunately, CPE has changed its pastoral care focus. It now takes no theological position, but includes students and Chaplains regardless of life style or religious worldview. Its training often emphasizes meeting psychological needs rather than primarily focusing on spiritual needs. Instead of being directed exclusively to healthcare chaplaincy, it takes any who desire to learn how to help the suffering in any specialized setting.

HCMA History

A more conservative, evangelical approach to clinical pastoral education for ministry in healthcare facilities began in 1939. This group is our group, now known as Healthcare Chaplains Ministry Association (HCMA).

The year was 1939. Miss Mina Septer, a missionary returned from Bolivia because of ill health, began visiting patients in the Los Angeles County General Hospital. There were so many patients entering the hospital expressing no preference for any religious denomination that she began visiting them regularly. She easily recognized the healthcare setting as a dynamic mission field in need of compassionate laborers. Soon a committee was formed consisting of: Ms. Mina Septer, Ms. May Cole, Dr. David Schmidt, Rev. Dudley Girod, Rev. P. Earl Fry, and Dr. Lowell C. Wendt. Hospital Gospel Ministry had begun!

When Miss Septer gave up the work because of ill health, the committee asked Rev. David Doerksen to assume the responsibility of “Chaplain” at the Los Angeles County General Hospital. Under his leadership, the ministry was presented to many churches in the Los Angeles area and many people became aware of this unique ministry. Later, Chaplain Doerksen returned to his former missionary field in Africa and Rev. William Collins assumed the chaplaincy until January 1950, when he resigned due to ill health. Rev. Ray S. Harris became the Chaplain at the Los Angeles County General Hospital, later becoming the first Executive Chaplain (now referred to as the Executive Director). At the same time, Miss May Cole, from the Bible Institute of Los Angeles was visiting TB patients at the Los Angeles County General Hospital and other sanitariums in the area.

In October 1951, the Hospital Gospel Ministry of America was incorporated. Those serving as the first directors of the corporation were: Lowell C. Wendt, Francis E. Green, P. Earl Fry, James O. Henry, Jennie S. Parry, Ray S. Harris, May H. Cole, David Schmidt, Kermit L. Byrd, Stanley Belland, and Fred A. Flora.

By January 1952, several hospitals in the Southern California area had opened their doors for a Chaplain: Rev. P. Earl Fry was placed in the Orange County General Hospital; Rev. Robert H. Manly was serving at Los Angeles County General Hospital, and Rev. John J. Penner replaced Rev. Ray S. Harris at Harbor General Hospital in Torrance, allowing Rev. Harris to devote more time to the position of Executive Chaplain.

In April 1957, the name of the organization was changed to the Hospital Chaplains’ Ministry of America, and the Articles of Incorporation were so amended.

During the ensuing years under the leadership of Executive Chaplain Harris, God blessed the ministry as hospital doors opened not only in California, but also in Oregon, Washington, and Arizona. Chaplain Harris resigned in December of 1965 and then devoted himself full-time to the chaplaincy at UCLA Medical Center.

In January of 1966, Dr. Stanley Belland was elected to the position of Executive Chaplain. At the time, Dr. Belland was serving as President of the Board of Directors and had served on the Board for many years. God continued blessing the ministry as hospital doors opened in Pennsylvania, Texas, Utah, and British Columbia. As the work expanded, it became impossible for the Executive Chaplain to cover the entire territory; therefore, the Board appointed qualified, fully certified Chaplains as Area Representatives (now known as Area Directors) to help with this great responsibility. Words cannot express the stability, leadership, integrity, and great compassion Chaplain Belland infused into the organization. God also blessed the ministry by bringing many dedicated men and women into the chaplaincy. Dr. Belland retired in August of 1985.

In December of 1985, Rev. Tom Delamater was appointed to the position of Executive Chaplain. Again, God blessed the ministry as hospital doors opened in Colorado, Kansas, Michigan, Illinois, and Texas. Chaplain Delamater had a keen sense of vision for the HCMA of training and equipping Chaplains and placing them in hospitals, great and small, throughout our country wherever the door opened. Chaplain Delamater held countless seminars for pastors to encourage them and to give them exposure to the vital ministry of HCMA. He also authored the first large training manual for the HCMA Chaplain-Trainees. Early in Chaplain Delamater’s administration (December 1986), an office was established in Anaheim, CA, bringing together all administrative and financial services in one place.

In November of 1990, Chaplain Timothy Malyon from Portland, Oregon, was appointed as the Associate Executive Chaplain to assist Executive Chaplain, Tom Delamater. Chaplain Malyon began serving in July of 1991. They served together with a goal of bringing excellence and professionalism to HCMA without compromise of ministry or purpose. Then in 1994, Chaplain Delamater retired from being Executive Chaplain in order to serve as the Ambassador at Large, working out of Missouri. There was a smooth transition when Chaplain Malyon was appointed as Executive Director of HCMA in January 1994.

Chaplain Malyon continued to seek to strengthen the HCMA by raising the standards for professionalism in the application and screening process. Through his leadership the HCMA was successful in revising the training curriculum, producing policy handbooks for the Chaplains and the Board of Directors, securing liability insurance for the Chaplains, Board and staff, and gaining recognition for the HCMA as a professional chaplaincy organization by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Chaplain Malyon took a deep interest in every Chaplain and encouraged them by visiting them at their hospital locations.

After a long bout with cancer, Tim went to be with the Lord in March 2000. Chaplain Jeffrey Funk capably succeeded him as Executive Director in May 2000. Jeffrey has continued Tim’s desire to have HCMA recognized as a national professional chaplaincy organization. Under his leadership, the Clinical Pastoral Training Curriculum was expanded to its current four Unit (1,600 hours) format, a Clinical Pastoral Training Manual for the Teaching Chaplains was developed, and the one-year Internship program and the certification process (including Professional Competency Standards) was strengthened. In 2002, under Jeffrey’s leadership, HCMA obtained recognition as a professional chaplaincy organization by the Coalition on Ministry in Specialized Settings (COMISS) Network. Also in 2002, Jeffrey edited and published the first edition of the HCMA Quarterly Update, an informative newsletter sent to all HCMA Chaplains and their Chaplain Assistants every quarter.

In January of 2005, HCMA changed its name once again. There were two areas that caused the Hospital Chaplains’ Ministry of America to seriously think about changing its name. One issue had to do with the fact that many of the HCMA Chaplains do not serve in a Hospital. The other involved the vision of HCMA broadening its ministry beyond the borders of America.

The primary focus of HCMA’s early ministry was on providing pastoral care to sick and suffering patients in hospitals. But the place of ministry has changed over the years. Many HCMA Chaplains currently provide needed spiritual counsel and comfort to residents in skilled nursing facilities (convalescent homes). HCMA also has numerous Hospice Chaplains serving throughout the United States. Therefore, the place of HCMA’s ministry is no longer solely confined within the walls of an acute care facility. It includes an important ministry of spiritual care across a much broader healthcare industry. This is why the HCMA Board of Directors changed the name from “Hospital Chaplains” to “Healthcare Chaplains.” It better reflects the involvement of HCMA Chaplains in different areas of healthcare ministry — acute care as well as long-term care and end-of-life care.

Throughout the decades, the main geography of the HCMA ministry had been within the borders of America. Even so, HCMA had been approached over the years by individuals from other countries who were interested in chaplaincy training. Unfortunately, HCMA had never felt qualified or equipped to adequately train Chaplains abroad. As a result, HCMA had always said, “No,” to these potential training candidates.

But circumstances have changed. With the advent of e-mail, the possibility of corresponding over long distances has been made much simpler and more economically feasible. In addition, HCMA has gained valuable experience in supervising and training Chaplains “at-a-distance” within the USA. That’s because some Trainees haven’t lived close to one of our Teaching Chaplains. HCMA has effectively prepared these distance learners to become competent pastoral caregivers at the bedside.

Because of this success with training American Chaplains at-a-distance, HCMA is broadening its borders to include training Chaplains from countries around the world. Therefore, the HCMA Board of Directors changed the name from “Hospital Chaplains’ Ministry of America” to “Healthcare Chaplains Ministry Association.” The word “association” implies a professional organization with no specific geographical boundaries.

This name change accomplished two important things. First, it clarified the identity of HCMA as a worldwide chaplaincy ministry within the healthcare arena. Second, it retained the identifiable letters: HCMA. Our former name implied a limited area of ministry. Our new name — Healthcare Chaplains Ministry Association (HCMA) — reflects a broader ministry focus.

In fulfillment of this global vision, the Executive Director went to West Africa in November of 2008 to teach a one-week basic chaplaincy training conference to Pastors in Nigeria and Sierra Leone.

God continues to send people of faith to serve with the HCMA. The prayer and vision of HCMA is that the Lord will give its members a ministry foothold throughout the world for this blessed and vital ministry.

___________________________

[1] W. Gibson, A Social History of the Domestic Chaplain, 1530-1840 (London, UK: Leicester University Press, 1997), 1-6.

[2] Ibid.

[3] Ibid.

[4] Wendy Cadge, Jeremy Freese, and Nicholas A. Christakis, “The Provision of Hospital Chaplaincy in the United States: A National Overview,” Southern Medical Journal 101, no. 6 (June 2008): 626-30.

[5]Anton T. Boisen, Out of the Depths: An Autobiographical Study of Mental Disorder and Religious Experience (New York, NY: Harper and Bros., 1960).

[6]Ibid.

[7]Richard Cabot and Russell Dicks published The Art of Ministering to the Sick (New York: Macmillan) in 1936. Dr. Cabot was the first Chaplain at Massachusetts General Hospital and the originator of the use of verbatim reports of pastoral visits in clinical pastoral education.

Resources

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__________, ed. Professional Chaplaincy: What Is Happening to It During Healthcare Reform? Binghamton, NY: Haworth Pastoral Press, 2000.
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