Beyond the 12 steps: Integrating chaplaincy services into Veteran Affairs substance use specialty care

Abstract

Background: Interprofessional training is increasing in focus within medical education. Although substance use treatment has long been interprofessional in nature, chaplaincy has been relatively absent in outpatient settings. Since 2013, the Veterans Health Administration has supported an Interprofessional Advanced Fellowship in Addiction Treatment (IAFAT), with 7 sites nationally recruiting across multiple health care disciplines. In the fall of 2017, Veteran Affairs Connecticut Healthcare System (VACHS) became the first such fellowship to expand its recruitment to include chaplain fellows. We seek to share rationale for recruiting chaplains, current curriculum and curricular needs, and the potential roles of chaplains in outpatient addiction treatment. Methods: Collaborating with the office of chaplaincy education, we describe the process of chaplain recruitment, incorporation into a new treatment setting, and supervision, and we report on the feasibility of this innovative training initiative. Results: During the first year, the chaplain fellow has developed and maintained a new clinical service in an outpatient substance use disorder (SUD) specialty care setting, delivering over 150 hours of group and individual treatment to veterans. He has provided 12 presentations to staff on the role of a chaplain and other related topics, as well as written an article on the topic of addiction for a clergy audience. Anecdotally, staff satisfaction has been high, and the current chaplain is helping to recruit for his replacement. Limitations: As a feasibility pilot project, there is no outcome and very limited quantitative data. Conclusions: Chaplain fellows can be successfully incorporated into outpatient SUD clinics with a noticeable degree of fellow, staff, and patient satisfaction.

Keywords:

• Chaplain
• spirituality
• pastoral care
• drug addiction
• outpatient clinics
• hospital
• alcoholics anonymous
• substance-use disorders
• religion

Acknowledgments

The authors thank Larissa Andreeva, MDiv, CaraBeth Wilson, Jana Hodges-Kluck for their feedback, corrections and editorial support.

Author contributions

Mr. Brian Earl is the main author and wrote entire original manuscript, decided the flow and format of the article, and implemented feedback and suggested edits from other contributors. Dr. Ellen Edens is the main editor. She read through, reviewed, and edited the entire manuscript several times. Her editing acted as a bridge between the chaplain fellow and the target audience of the Substance Abuse journal. She also added a layer of professional polish on the wording, phrasing, and delivery of the content. Dr. Anne Klee is a contributing author. She reviewed the article, providing feedback that helped the flow of the article, and helped write the portion of the article on the context of the medical climate of today. Mr. James Cooke is a contributing author. He primarily contributed feedback and writing on portions involving CPE, chaplaincy training, and chaplaincy competencies. In addition, he reviewed the article, providing grammatical edits and feedback.