J Relig Health (2016) 55:1206–1214 DOI 10.1007/s10943-016-0223-x ORIGINAL PAPER
How Involved are Non-VA Chaplains in Supporting Veterans? Marek S. Kopacz1 • Bruce D. Feldstein2,3 • Cecille Allman Asekoff3 Maurice S. Kaprow3 • Rebecca Smith-Coggins2 • Kathy A. Rasmussen1,4
•
Published online: 29 March 2016 Ó Springer Science+Business Media New York (outside the USA) 2016
Abstract In terms of supporting veteran populations, little is known of the experiences of chaplains professionally active outside of Department of Veterans Affairs (VA) healthcare settings. The present study looks to examine how involved non-VA chaplains are in supporting veterans as well as their familiarity with the VA. An online survey was distributed in a convenience sample of chaplains, of which n = 39 met the inclusion criterion for this study (i.e., no past or present VA affiliation). The results find that most of the nonVA chaplains encounter veteran service users either on a weekly or monthly basis. Though familiar with VA services, non-VA chaplains were not sure of their veteran service users’ VA enrollment status nor did they feel able to adequately advise their veteran service users on VA enrollment. The results suggest that non-VA chaplains actively support veteran populations. Opportunities for enhancing chaplaincy services and VA outreach programs are discussed. Keywords
Veterans Non-VA Community health
The views expressed are those of the authors and do not reflect the official policy or position of the Department of Veterans Affairs or the US Government. & Marek S. Kopacz
[email protected] 1
US Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA
2
Stanford University School of Medicine, Stanford, CA, USA
3
Neshama: Association of Jewish Chaplains, Whippany, NJ, USA
4
University of Rochester Medical Center, Rochester, NY, USA
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Introduction Chaplains are a recognized source of support for veteran populations. An extensive literature has highlighted the contribution of chaplains in supporting the psychosocial wellbeing and mental health of veterans (e.g., Nieuwsma et al. 2013). Most of the literature examining how chaplains support veterans has, however, been limited to the experiences of chaplains affiliated with the Department of Veterans Affairs (VA), who provide their services at VA healthcare facilities. Little is known of the experiences of non-VA chaplains (i.e., those with no past or present VA affiliation). Based on FY2014 estimates, 57.9 % of America’s veterans were not VA-enrolled and 72.7 % sought healthcare services outside the VA (Bagalman 2014). Examining the involvement of non-VA chaplains in supporting veterans as well as their familiarity with the VA is important for a variety of reasons. First, community outreach remains a central element of recent efforts by the VA to enhance access to and awareness of its services. The VA actively engages with a variety of community outlets, including faith-based communities (U.S. Department of Veterans Affairs 2015). Many veterans are involved with faith-based communities and see these communities as a resource for support in times of need (House Committee on Veterans’ Affairs 2012). Second, a number of chaplains are professionally active in their local area and not necessarily involved with healthcare institutions. For example, they may serve as leaders of their respective faith communities or be affiliated with different groups/organizations. In these circumstances, chaplains will sometimes encounter individuals whose need for support will sometimes exceed their ability to help. This may include a need for facilitating access to formal healthcare services (Taylor et al. 2000). In such cases, non-VA chaplains may serve as gatekeepers to health care for their service users. Yet one study found collaboration between formal provider systems and faith-based communities to be notably absent (Blank et al. 2002). Lastly, facilitating access to VA healthcare services could potentially serve a strategic role in public health efforts. For example, certain veteran populations have been found to be at increased risk of suicide relative to the general population (Kang et al. 2015). Of note is that veterans enrolled in VA health care appear to be at lower risk of death by suicide compared to veterans not enrolled in VA services (Hoffmire et al. 2015). To this end, knowing how to facilitate access to VA healthcare services is of vital importance should a chaplain ever encounter a veteran at increased risk of suicide or otherwise in urgent need of formal healthcare services. Accordingly, the present study looks to examine how involved non-VA chaplains are in supporting veterans as well as their familiarity with the VA. Such familiarity might serve as an indicator of how prepared non-VA chaplains are for facilitating access to VA services among their veteran service users. The findings could, in turn, serve to identify opportunities for enhancing VA outreach efforts as well as enhancing chaplaincy services to more effectively meet the needs of veterans.
Methods The sample population for the present study included American chaplains affiliated with Neshama: Association of Jewish Chaplains (NAJC), a membership-based organization of professional chaplains, who are not presently and have not been previously affiliated with
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the VA. Data for the present analysis were collected using an online survey designed in collaboration with senior NAJC leadership and a team of VA researchers. The purpose of this survey was to better inform the services already being provided by NAJC chaplains to veteran populations. The present analysis examines thirteen variables drawing from this survey. This study was approved by the Institutional Review Board at Stanford University. The survey was first pilot-tested for clarity and relevance in a group of NAJC chaplains who voiced approval of the survey questions and answer options. The survey was then uploaded to SurveyMonkey, an online survey service. Once uploaded, SurveyMonkey assigns a unique Internet link to access a particular survey. Responses were collected and anonymously stored on the SurveyMonkey Web site (i.e., without any respondent-identifying data, such as e-mail, names, or IP addresses). At the end of data collection, responses were downloaded from the SurveyMonkey Web site as an MS Excel file. Participants were recruited using the internal listserv of NAJC chaplains. All individuals included on this listserv were first sent an e-mail inviting them to complete the survey. This invitation letter, signed by the NAJC Acting President, described the purpose of the survey, underlined the voluntary and anonymous nature of participation, and included the SurveyMonkey link which could be used to directly connect to the survey. A reminder e-mail was sent approximately 2 weeks later. The survey was open to completion for 4 weeks. After this time, the Internet link was deactivated and the survey closed to completion.
Inclusion Criterion To discern their VA affiliation, respondents were asked ‘‘Are you currently or have you ever been affiliated with the US Department of Veterans Affairs (VA) as a full-time, parttime, fee-basis, student, or volunteer chaplain?’’ Answer options included yes or no. The present analysis only includes those respondents who answered no. Respondents who answered yes or left this question blank were excluded from the present analysis.
Demographics Demographic variables included gender (Q1) and age (Q2). Gender answer options included male or female. Age answer options included 20–30, 31–40, 41–50, 51–60, or [60. Respondents were also asked (Q3) ‘‘Are you presently serving (i.e., active duty or reserve status) or have you ever served (i.e., veteran status) in the armed services of your country?’’ Answer options for this question included yes or no.
Professional Development Respondents were first asked (Q4) ‘‘What is your highest level of education?’’ Answer options included High School/GED, Some College/Associate’s Degree/Technical School, Bachelor’s Degree, Master’s Degree, Doctoral Degree, or Other. Next, respondents were asked (Q5) ‘‘Do you have any formal Clinical Pastoral Education (CPE) training?’’ Answer options included None, 1–2 units, 3–4 units, or 5? units. One CPE unit typically includes 400 hundred hours of combined practical chaplaincy experience and formal education/professional development.
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Lastly, respondents were asked (Q6) ‘‘For how many years have you been professionally active as a chaplain?’’ Answers options included \5, 6–10, 11–15, 16–20, or[20.
Service Users Respondents were asked (Q7) ‘‘Considering the individuals for whom you provide chaplaincy services, approximately what percentage would you say are NOT Jewish?’’ Answer options included 0, \5, 5–10, 10–20, or [20. Next, respondents were asked (Q8) ‘‘Do you ever conduct a military history with individuals under your care?’’ Answer options included Yes, No, or Not Sure. This was followed by (Q9) ‘‘In the course of your work as a chaplain, how often do you encounter veterans (not active duty or reserve duty)?’’ Answer options included Never, Less than monthly, Monthly, Weekly, Daily or almost daily, or Not sure.
Table 1 Non-VA chaplain demographics and professional development
Variables
N (%)
Gender Male
19 (48.72)
Female
20 (51.28)
Age 20–30
1 (2.56)
31–40
4 (10.26)
41–50
5 (12.82)
51–60
10 (25.64)
60?
19 (48.72)
Military servicea Yes
6 (15.79)
No
32 (84.21)
What is your highest level of education? High School/GED
0 (0)
Some College/Associate Degree/Technical School
0 (0)
Bachelor’s Degree
2 (5.13)
Master’s Degree
22 (56.41)
Doctoral Degree
12 (30.77)
Other
3 (7.69)
CPE training None
3 (7.69)
1–2 units
4 (10.26)
3–4 units
25 (64.10)
5? units
7 (17.95)
Years professionally active
a
Question left blank by one respondent
\5
13 (33.33)
6–10
13 (33.33)
11–15
2 (5.13)
16–20
5 (12.82)
[20
6 (15.38)
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Lastly, respondents were asked (Q10) ‘‘How many veterans do you actually see in any given month?’’ Answer options included B5, 6–10, 11–15, 16–20, or C21.
Familiarity with the VA Respondents were first asked (Q11) ‘‘To the best of your knowledge, are the veterans under your care enrolled in VA health care services?’’ Answer options included Not sure, Most or Table 2 Non-VA chaplain involvement with veterans and familiarity with the VA
Variables
N (%)
Non-Jewish service users 0%
1 (2.56)
\5 %
6 (15.38)
5–10 %
4 (10.26)
10–20 %
5 (12.82)
[20 %
23 (58.97)
Conducts military history Yes
13 (33.33)
No
20 (51.26)
Not sure
6 (15.38)
Encounters with veterans Never Less than monthly
0 (0) 7 (17.95)
Monthly
13 (33.33)
Weekly
15 (38.46)
Daily or almost daily
4 (10.26)
Not sure
0 (0)
Number of veterans seen monthlya B5
22 (57.89)
6–10
11 (28.95)
11–15
4 (10.53)
16–20
1 (2.63)
C21
0 (0)
Veteran enrollment in VA healthcare services Not sure
19 (50.00)
Most or almost all are enrolled
12 (31.58)
About evenly divided
6 (15.79)
Most or almost all are not enrolled
1 (2.63)
Knowing how to advise on VA enrollment Yes
14 (35.90)
No
14 (35.90)
Not sure
11 (28.21)
Familiar with VA services
a
Question left blank by one respondent
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Yes
31 (79.49)
No
8 (20.51)
Not sure
0 (0)
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almost all are enrolled, About evenly divided between those who are enrolled and not enrolled, or Most or almost all are not enrolled. Next, (Q12) ‘‘If a veteran voiced a desire or interest in enrolling in VA health care services, would you know how to advise him/her to proceed?’’ Answer options included Yes, No, or Not sure. Lastly, respondents were asked (Q13) ‘‘Are you aware that besides providing general health care services, the VA also offers eligible veterans a variety of specialized programs and support options?’’ Answer options included Yes, No, or Not sure.
Statistical Analysis The frequency distribution of responses is presented in descriptive format—N (%)—for each question.
Results The NAJC Listserv included 365 American chaplains, of which 70 (19.2 %) responded to the survey. From this group, 39 (55.7 %) met the inclusion criterion for the present analysis. Table 1 presents the frequency distribution of responses to the demographics and professional development variables. Table 2 presents the frequency distribution of responses to the variables examining involvement with veterans and familiarity with the VA.
Demographics There were 19 (48.7 %) male respondents and 20 (51.3 %) female respondents. Most respondents reported being aged [60 years (n = 19, 48.7 %). The majority did not report any military service (n = 32, 82.1 %).
Professional Development Most respondents reported having a Master’s level education (n = 22, 56.4 %) and 3–4 units of CPE (n = 25, 64.1 %). Most respondents reported being professionally active as a chaplain for either \5 (n = 13, 33.3 %) or 6–10 years (n = 13, 33.3 %).
Service Users The majority of respondents (n = 23, 59.0 %) reported having [20 % non-Jewish service users. Most respondents reported not taking a military history (n = 20, 51.3 %) with their service users. Respondents reported encountering veteran service users either weekly (n = 15, 38.5 %) or monthly (n = 13, 33.3 %). This usually worked out to either B5 (n = 22, 56.4 %) or 6–10 (n = 11, 28.2 %) veterans in any given month. No respondents reported never encountering veterans.
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Familiarity with the VA Most respondents reported being either not sure (n = 19, 48.7 %) whether the veterans under their care are enrolled in VA services or that most or almost all (n = 12, 30.8 %) are enrolled. The majority of respondents did not know (n = 14, 35.9 %) or were not sure (n = 11, 28.2 %) how to advise their veteran service users to enroll in VA services. Also, the majority of respondents (n = 31, 79.5 %) reported being aware of specialized programs and support options offered by the VA.
Discussion This study examined the involvement of non-VA chaplains in supporting veterans as well as the familiarity of these chaplains with the VA. The acting assumption was that familiarity with the VA could serve as a marker of how prepared non-VA chaplains might be for facilitating access to VA health care. The results find that most of the sample population encounters veteran service users either on a weekly or monthly basis. Though familiar with VA services, the sample was not sure of their veteran service users’ VA enrollment status nor did they feel able to adequately advise their veteran service users on VA enrollment. The present study yielded several noteworthy findings. Despite working outside of VA healthcare settings, these chaplains appear to have relatively regular professional contact with veterans. Further, while the sample population was limited to Jewish chaplains, respondents reported supporting a diverse population of service users (i.e., not limited only to members of the Jewish faith). This highlights how a number of factors, not limited only to faith affiliation, are related to the use of chaplaincy services. Interestingly, the sample population also had approximately equal numbers of male and female chaplains. The findings from this study could be used to better inform chaplaincy practice. NonVA chaplains should consider making military histories a standard part of their service encounters. One option might be incorporating military histories into spiritual assessments. This could allow for placing the chaplaincy encounter on a ‘‘track’’ most appropriate to the needs of the veteran service users (e.g., spiritual distress resulting from military experiences). Taking a military history could also serve an added purpose—it is the first step in establishing potential eligibility for VA healthcare services. In particular, in the case of veterans who may be in need of healthcare services, it would be prudent for chaplains to also inquire whether their veteran service users are presently enrolled in VA services. It stands to reason that, at a community level, chaplains may be able to offer some assistance, such as providing contact information to veterans interested in VA enrollment. The findings also underscore the potential for enhancing VA outreach efforts to faithbased communities. One option could be to incorporate outreach efforts into existing community-based services, which could also serve to increase familiarity with the VA among non-VA chaplains and community faith leaders. For example, a number of faith groups actively support homeless populations, inclusive of homeless veterans (U.S. Department of Veterans Affairs 2014a). Further, it would also be advantageous to engage faith group leaders. This could mean incorporating a basic level of knowledge about the VA (e.g., available services, eligibility categories, enrollment procedures) into ministerial or chaplaincy training programs, most of which already include some type of military/ veteran component.
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One option for connecting directly with the VA is the Veterans Crisis Line (VCL; 1-800-273-8255 and press 1), a publically available VA service for veterans and their families, friends, and caregivers. Chaplains who feel their veteran service users may be in crisis and/or in urgent need of health care or other supportive services are able to contact the VCL for guidance. The VCL can serve as a gateway to VA services for eligible veterans not otherwise in the VA system (Britton et al. 2015). It could also serve to connect veterans in need with resources in their local community. The findings of the present study should be interpreted in the context of several limitations. The sample population represents only a narrow segment of NAJC chaplains. The findings are not, therefore, necessarily representative or generalizable to the wider population of chaplaincy or spiritual and pastoral care providers. Chaplains’ ability to engage veterans in VA services can vary with other factors besides familiarity with the VA, past or present VA affiliation, or training on taking a military history. In recent years, the VA has undertaken considerable efforts to improve access to its healthcare services for America’s growing population of veterans (American Public Health Association 2014; U.S. Department of Veterans Affairs & U.S. Department of Defense 2014; U.S. Department of Veterans Affairs 2014a, b). Part of this effort includes community outreach to faith-based communities. The findings of the present study highlight the involvement of non-VA chaplains in supporting veterans, in addition to suggesting options which could be used to enhance outreach efforts as well as enhancing chaplaincy services to better meet the needs of veterans. Acknowledgments Dr. Rasmussen was supported by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, US Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention. Institutional support for this study was provided by the VISN 2 Center of Excellence for Suicide Prevention (Canandaigua, NY) and Neshama: Association of Jewish Chaplains (Whippany, NJ). The views expressed are those of the authors and do not reflect the official policy or position of the Department of Veterans Affairs or the US Government. Compliance with Ethical Standards Conflicts of interest None of the authors voice any conflicts of interest related to the conduct of this research activity. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This survey study received IRB approval from Stanford University and was conducted independent of any external grant funding. Institutional support for this study was provided by the VISN 2 Center of Excellence for Suicide Prevention (Canandaigua, NY) and Neshama: Association of Jewish Chaplains (Whippany, NJ). Informed Consent As per IRB approval, this study was exempt from collecting written informed consent.
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