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And Clinical Pastoral Education At The Hospital Of The University Of Pennsylvania by Dr. Jeff Stanley and Chaplain Ralph Ciampa May 2002 Contents
1. Introduction
No one walks alone through the halls of the University of Pennsylvania Medical Center (UPMC). All...who travel through the School of Medicine and the Hospital of the University of Pennsylvania are accompanied by...memorabilia...that tell in passing a history...that extends...further than any other American medical school can claim. [David Y. Cooper, III and Marshall A. Ledger, Innovation and Tradition at the University of Pennsylvania School of Medicine (Philadelphia: University of Pennsylvania Press, 1990)]The University of Pennsylvania School of Medicine was founded in 1765 as the nation's first college of medicine. Two American physicians, Dr. John Morgan and Dr. William Shippen, returned from their medical studies in Edinburgh and convinced the trustees of Benjamin Franklin's College of Philadelphia (later the University of Pennsylvania) that the study of medicine rightfully belonged in the College. Shippen taught anatomy and midwifery and Morgan taught physics. About 20 students paid $20 each for the series of medical lectures. Pennsylvania Hospital, the nation's first hospital founded by Franklin in 1751, and the Philadelphia Almshouse became the clinical venues of the new medical college. From 1765 to 1865 more than 100 medical schools rose and fell across America (56 in Philadelphia alone), but the tiny college of Morgan, Shippen, and Franklin remained preeminent. The Hospital of the University of Pennsylvania (HUP) opened in 1874 on land sold by the City of Philadelphia for $500 with the stipulation that the hospital provide free care for the needy, amounting to not less than 50 beds. Thus HUP became the first hospital in the nation built by a university for the express purpose of teaching medical students. By 1992, the medical center consisted of the School of Medicine, HUP and HUP's physician organization, the Clinical Practices of the University of Pennsylvania. [Regarding further expansion, see Section 12, below.] Together, these three units are committed to quaternary care: the concept of bringing basic research to the bedside as soon as possible. With its current complement of 14 buildings (including one in continuous use since 1883), 2,000 medical faculty and resident physicians, 1,000 students of medicine, nursing, and allied health professions; and 3,000 other personnel, the University of Pennsylvania Medical Center provides care to 26,000 patients admitted annually to 722 beds. Each year the Medical Center also cares for 350,000 Ambulatory Care and 55,000 Emergency Department patient visits. In a typical year, patients are admitted from every region of the United States and from 40 other countries. However, the primary source of patients is the area immediately surrounding the University of Pennsylvania, including neighborhoods in racial and ethnic transition and many neighborhoods with endemic problems of poverty: crime, poor health status, drug and alcohol addictions, and an infant mortality rate higher than that of many Third World countries. To achieve balance among the elements of the tripartite mission of the Medical Center--education, research, and patient care--the hospital's own mission was restated in 1990: Caring for our patients with respect and compassion in a setting where patients benefit from the application of the latest medical and scientific advances delivered with skill, integrity, and constant concern for their comfort and well being. Such a rededication was fitting and poignant, as it fell upon the 225th anniversary of the founding of the School of Medicine. 2. Dates in the History of Ministry and CPE at HUP
3. The 19th Century: Historical Antecedents of CPEDespite the strong Calvinist and Quaker presence in colonial Philadelphia, there were no formal religious ties to either the School of Medicine or HUP. Even the charitable care proviso that created the hospital was more a secular and political necessity than a religious goal. The School of Medicine itself was historically the brunt of religious anger over charges (mostly unfounded) of grave robbing, desecration, vivisection, and gold- digging. The earliest glimpses of a religious presence within the hospital comes from the anecdotally-rich Annual Reports of the Board of Managers of HUP, published since 1876. From the beginning, informal worship services were held throughout the hospital wards on Sunday afternoons and were usually led by a resident physician or visiting clergy. The Board of Women Visitors, formed primarily to oversee housekeeping and to supervise the bed and linen services, soon began to orchestrate the Sunday (predominantly Christian) services. Philadelphia's clergy were free to visit their congregation members in the hospital, and since the average inpatient stay was more than 29 days, such visits were especially welcomed. The first apparent ties to any church came in 1888, when the Flower Mission of the Tabernacle Church began to place fresh cut flowers on the hospital wards twice weekly to comfort the patients. In 1890, with an $11,000 gift of Mrs. Charles Harrison of the Board of Women Visitors, the hospital erected its first mortuary: a small building "capable of holding 12 corpses on ice" [Report of the Board of Managers of the Hospital of the University of Pennsylvania, 1890]. A small Mortuary Chapel was built alongside—the first Chapel at HUP. By the mid 1890s, the Philadelphia Bible Society and the American Bible House had begun to donate a few Bibles for the patients, and the Board of Women Visitors began to appropriate $2.16 for hymnals each year. At Christmas and Easter, the Benevolent Committee of the Board of Women Visitors, led by Prof. Oscar Abrahamsohn, provided special holiday meals, ice cream treats, decorated Christmas trees, and small gifts for the patients and the nursing students. The Annual Report of 1898 recorded 222 Sunday services, faithfully led by a religious pillar of early HUP, Miss Mary B. Wharton, and 26 newborn christenings by visiting clergy. The Benevolent Committee had also begun to visit patients throughout the hospital each Tuesday to bring cheer, comfort and amenities. In 1899, the Board of Women Visitors, reacting to increased patient needs, first hired a young Miss Clarkson as a ward "missionary": a "professional" patient visitor with a charitable, but not explicitly religious, intent. The "missionary" was paid $105 per year for 10 hours of visiting each week; she was allocated $15.50 each year to provide for patients' needs. In 1899, the Auxiliary Committee for the Maternity Ward, a volunteer group, first began to hire a clergyman to visit the "sad women" of the Maternity Ward: We have long felt that it was unsatisfactory to leave the visiting of patients by a clergyman to be determined by chance, and are, therefore, glad to say that we have made a definite arrangement for a clergyman to visit them every Thursday afternoon.... [H]e baptized three women and 60 children.... [He is ready] to respond to special calls to visit the ward whenever a patient may wish to see him. We know of one instance at least when he was sent for in the middle of the night by a dying woman who wished to be baptized. [Report of the Board of Managers of the Hospital of the University of Pennsylvania, 1900, pp. 43, 44]The Rev. Lobdell was paid $25 per quarter for his visits. By 1907, HUP admissions had risen to nearly 5,000 per year and the hospital still had no room for religious services except the Mortuary Chapel. A poignant plea for a (new) Chapel came in the 1907 report of the Board of Women Visitors: The Sunday services for the hospital family have been well attended, especially by men. The Board earnestly wishes that a more appropriate and attractive room might be set aside as a Chapel for these services. Will not some friend of the Hospital furnish such a room, giving also a really good organ, which is needed? [Report of the Board of Managers of the Hospital of the University of Pennsylvania 1907, p 41] By 1911, the Board of Women Visitors' "missionary" visitor, Miss Fougeray, was paid $440.50 per year. She was praised for "doing patiently and kindly a thousand deeds of charity and mercy for which gratitude and sincere appreciation is always expressed by the patients" [Report of the Board of Managers of the Hospital of the University of Pennsylvania, 1911]. Over the next decade, a succession of Reverends each received $25 per quarter to supervise Sunday services. Then, in the 1920s and 1930s, the Sunday services were actually led by resident physicians. By 1939, a new presence was felt in the Hospital: the School of Arts and Sciences. Sunday services were led by two young Divinity students under the supervision of the University Chaplain, Rev. W. Brooke Stabler. Three undergraduate women taught Kindergarten Sunday School. The University of Pennsylvania Chaplain, Rev. J. Clemens Kolb, who joined the University in 1941, took an active interest in the hospital as well as the nursing and medical schools. He inaugurated a series of four lectures for the nursing students on euthanasia, the psychology of the patient, the patient and death, and religious opportunities for nurses. By 1948, his lectures to the Penn medical students on the relationship between clergy and physician were required for graduation. And by 1949, he had established a colloquium on death and the role of clergy in the care of terminal cancer patients. The thrust of theological and pastoral inquiry to the patient's bedside was established long before formal CPE was envisioned at HUP. In 1948, some 40 years after the Board of Women Visitors' plaintive plea, the first hospital Chapel was erected in the historic Dulles building. Six years later, in 1954, the Chapel was moved to its present location, and dedicated in the memory of Mrs. William W. Arnett, the 90-year-old Distinguished Daughter of Pennsylvania and faithful member of the Women's Board since 1898. In the 1950s, the Board of Women Visitors assumed all financial responsibility for Sunday services in the Chapel. The budget totaled just $400 per year. By 1962, the HUP Office of Volunteers proudly counted 847 volunteers who donated 42,000 hours in charitable service. From these volunteers, and from many clergy and religious lay leaders, would come the beginnings of formal pastoral care. 4. The Modern Era: The Interfaith Chaplaincy Service EstablishedThough pastors, priests and rabbis had been welcomed at HUP since the hospital opened in 1874, organized pastoral care really arose in the early 1960s, when the hospital began to coordinate visitation by officially appointed clergy. The selected clergy, representing diverse faiths, were drawn from the Interfaith Council on Chaplaincy Ministry, an arm of the Metropolitan Christian Council of Philadelphia. These volunteer chaplains became affectionately known as the HUP "House Committee," whose charitable deeds were coordinated through the hospital's Office of Volunteers. From its inception, the "House Committee," or Interfaith Chaplaincy Service, was dedicated to two themes which have persisted until today: 1) the pluralistic nature of our hospital and the need for ecumenical ministry and 2) the wisdom of engaging surrounding faith communities in pastoral care at HUP. In 1974, Rev. John Pumphrey was chosen as Coordinator of the Interfaith Chaplaincy Service and was named Hospital Chaplain, a position fully funded by Episcopal Community Services of Philadelphia, a social service agency of the Episcopal Diocese of Pennsylvania. One year later, the Coordinator/Hospital Chaplain was administratively reclassified as a hospital Department Head, even though he was still a full-time HUP volunteer funded by the Episcopal Diocese. Three years later, in 1977, the hospital first began to provide budgetary support for the Interfaith Chaplaincy Service, gradually supplanting the faithful and generous support from the Episcopal Diocese over the next decade. 5. Roots Secured: The Department of Pastoral Care EvolvesWith the dawn of the 1980s, the Interfaith Chaplaincy Service had been so firmly rooted and lovingly cultivated that it had begun to outgrow its original soil and pot. New opportunities called for new vision and a new relationship between HUP Chaplaincy and the Episcopal Community Services. So in 1981, the Interfaith Chaplaincy Service was christened the first Department of Pastoral Care at HUP. The Hospital Chaplain, whose title was now Head of the Department of Pastoral Care, continued to be provided to HUP by Episcopal Community Services, but now on a contractual basis for reimbursement. The Interfaith Chaplaincy membership continued to serve the hospital as volunteer clergy appointed by diverse faith groups for visitation. 6. Pastoral Education Begins at HUPAs befits the nation's first university-based hospital, HUP has a long and historical commitment to education, not only of young physicians and nurses, but also of young clergy. For many years, HUP's chaplains taught extensively as Field Placement Supervisors for students of the Philadelphia Divinity School, which is now closed. Rev. Pumphrey continued this tradition by teaching lay chaplains, college students bound for seminary, and graduate students in religion at the University of Pennsylvania. For several years, also under Rev. Pumphrey's guidance, students from the Pennsylvania Foundation for Pastoral Counseling spent two days per week at HUP as their practicum experience. As early as 1976, CPE had become a committed goal of the HUP Department of Pastoral Care. The original plan was to use HUP as a clinical site for a combined University of Pennsylvania Medical Center-Presbyterian Medical Center pastoral education program. During the summer of 1978, the first student from the Presbyterian CPE program was successfully placed at HUP. The first CPE was offered at HUP in 1979 through a satellite arrangement with Presbyterian Medical Center in West Philadelphia. The first four HUP chaplaincy students were very well received, especially by the hospital's nursing staff. This auspicious inaugural program allowed Rev. Pumphrey to complete his CPE Supervisory training under Chaplain Dan DeArment at Presbyterian in 1980. By the fall of 1980, a formal CPE Professional Advisory Committee had been established as the natural outgrowth of its predecessor, the Ad Hoc Medical Board Committee for Chaplaincy. Based on the Professional Consultation Committee's painstaking Feasibility Study, HUP applied in 1981 to the ACPE Eastern Region Accreditation Committee for candidacy as a CPE center. In March 1981, HUP was granted candidacy accreditation to offer Basic CPE. In 1981, 1982 and 1984, under Rev. Pumphrey's guidance, fourteen students completed summer units of CPE at HUP. In 1983, six students completed the first extended unit of CPE at HUP. 7. Full Accreditation for Basic and Advanced CPE at HUPIn May 1985, HUP received ACPE accreditation to offer both Basic and Advanced CPE. Out of that initial self-study and site visit grew a task force to study the feasibility of a chaplaincy residency at HUP. Though judged desirable, the residency's birth was delayed by financial and space constraints. Summer CPE continued to flourish from 1985 through 1991. During these six years, 16 men and 12 women enriched HUP's ministry and their own education through the hospital's Summer CPE program. In the fall of 1988, Rev. Pumphrey left HUP to become Director of Pastoral Care in a multi-hospital center in Delaware. Chaplain Pamela Flinn, whose work both at HUP and the Presbyterian Medical Center had earned her Associate Supervisor status, was named Interim Director of Pastoral Care at HUP. When Chaplain Flinn left HUP in 1989, Chaplains Dan DeArment and Ralph Ciampa of Presbyterian Medical Center contracted with HUP to coordinate CPE care here. During 1989-1990, two chaplain residents from the Presbyterian Medical Center CPE program were assigned to ministry at HUP. Five part-time CPE students also joined the program at HUP: they received small stipends in exchange for covering night chaplaincy duties during the week at HUP. Thus, by 1990, HUP was able for the first time to offer 24-hour per day, 7-day per week, in-house pastoral care. 8. Commitment to CPE Residency Grows: Ciampa Named DirectorIn July 1990, Rev. Ralph Ciampa was named Director of the Department of Pastoral Care, and was charged with establishing a full-time CPE residency program exclusive to HUP. Rev. Ciampa immediately led a successful effort to secure financial support for the residency. By 1990-1991, two new residency stipends had been established. One stipend was used to support Sister Dorothy Ward, a 1989 alumna of the HUP CPE program, as a part-time staff chaplain primarily devoted to the new Level I Trauma program at HUP. Two full-time CPE residents and three part-time students were integrated into a combined program with the Presbyterian Medical Center, under the supervision of Rev. DeArment and Rev. Ciampa. In June 1991, with the strong advocacy of Dr. William Schwab, Chief of Trauma Surgery, and with the financial support of the Board of Women Visitors, a full-time staff chaplain position, devoted primarily to trauma, was created; and Sister Dorothy Ward was recruited to fill it. The HUP Board of Women Visitors, who fully renovated the hospital Chapel in the early 1980s, has long been a strong and greatly valued ally of the CPE program. In the summer of 1991, Rev. Joseph Leggieri of Methodist Hospital led six students through the summer CPE program at HUP as a supervisor-in-training under the auspices of the Presbyterian Medical Center and with the supervision of Rev. Ciampa. With the great success of Rev. Leggieri's summer supervisory program, the next goal of HUP's CPE program was thus established: accreditation in 1992 for Supervisory Education at HUP. In support of that goal, Chaplain Ciampa continued his participation in monthly Eastern Pennsylvania Supervisory Education Consortium meetings at Lehigh Valley Hospital, along with supervisors and supervisors-in-training from the Presbyterian Medical Center, Geisinger Medical Center, Hershey Medical Center, and from the Delaware Valley. In September 1991, five fully-stipended CPE residents began their nine-month program at HUP under the supervision of Chaplain Ciampa. The five HUP residents continued to share joint clinical seminars with the CPE residents from the Presbyterian Medical Center, who were now under the supervision of Presbyterian CPE Director Dan DeArment and Associate Director Pamela Flinn. The warm friendship and mutual support shared by the CPE programs at HUP and Presbyterian continued to broaden and enrich the pastoral education of students from both centers. 9. Synergistic Growth: CPE at HUPIn 1991, after years of faithful service by Chaplains Pumphrey, Flinn, and Ciampa, the HUP CPE program began truly to flourish. The CPE Professional Consultation Committee, which by then included prominent physicians, nurses, administrators, and West Philadelphia clergy, had helped to advise the Pastoral Care leadership and to champion the cause of CPE at HUP. Most sanguine for the future of CPE at HUP were the arrivals in 1988 of Dr. William N. Kelley as Dean and Chief Executive Officer of the University of Pennsylvania Medical Center (UPMC) and Mr. Wilbur B. Pittinger as CEO of HUP. This signaled a new era of growth for medicine at Penn and for the CPE program at HUP. Their energetic leadership and commitment to reestablish UPMC as one of the nation's top five medical centers brought a new emphasis on innovative hospital management and a new focus on the quality of patient care. Increased efficiencies and enhanced utilization led to dramatic financial gains for the institution and a period of new and stable growth. During the first three years of the Kelley-Pittinger era, the CPE program at HUP dramatically increased the scope and diversity of its chaplaincy services to patients and staff at the medical center. On-site pastoral care was extended to 24-hours a day, 7-days per week; full-time pastoral support was dedicated to the Trauma and Emergency services; hospital ceremonies, sacraments, and religious offerings were greatly expanded; and most importantly, patient visitations and crisis interventions were increased fully ten-fold to a level of 28,000 pastoral care visits in 1991-1992. Through the gifted advocacy of Associate Administrators Sandra Stein and Frances Anderson, both of whom served on the CPE Professional Consultation Committee, Dr. Kelley, Mr. Pittinger, and the leadership at UPMC came to recognize clearly the importance of a superlative pastoral care program at HUP. To ensure the vigor and growth of the CPE program at HUP, they made a strong investment in its future. So it is that the 1993 Annual Budget for the Department of Pastoral Care totaled $244,000, a 355% increase from 1989. Strong institutional support for CPE at HUP dramatically strengthened the hospital's pastoral care education program. Five permanent, full-time residency positions were consolidated in the annual budget process of the UPMC. A full-time Department secretary, Ms. Rita Haigh, was hired in October 1991. The Pastoral Care offices and the Volunteer Chaplaincy office, located in the historic Dulles building contiguous to the hospital Chapel, were redecorated and computerized. In January 1992, a new and fully renovated CPE Seminar Room, new CPE students' office, and improved on-call quarters for the night chaplain were also provided by the Medical Center. Finally, construction of a greatly needed HUP Emergency Department Consolation and Grieving Room began in June 1992. The dawn of 1992 brought a focus of community outreach to the CPE program. A part-time Extended CPE program at HUP, under the supervision of Chaplain Priscilla Denham of Jeannes Hospital in Philadelphia, was established. In September 1992, this program extended HUP's educational thrust to chaplains unable to leave full-time careers to pursue further pastoral education. The Department of Pastoral Care, through the work of the CPE Professional Consultation Committee, began a CPE Alumni/ae Association, to counsel CPE leaders. The Department also continued to involve the community clergy with CPE at HUP: Chaplain Ciampa continued to teach a 10-week introductory course in hospital ministry at the Urban Theological Institute of the Lutheran Theological Seminary of Philadelphia and a 15-week course on hospital ministry for the Episcopal Diocese of Philadelphia. In May 1992, Chaplain Ciampa and Rev. William Shaw of the White Rock Baptist Church led a symposium on the pastoral care needs of trauma victims for West Philadelphia clergy. 10. Summary Thoughts from the Vantage Point of 1992From their historic beginnings, the University of Pennsylvania School of Medicine and the Hospital of the University of Pennsylvania have both grown and prospered over the past two centuries. Both institutions have a proud heritage of education and service. Pastoral care has always been an important part of the clinical healing mission of the hospital. CPE at HUP began with a single student in 1978. From then until 1992, 39 men and 34 women completed nearly 90 units of CPE here. These men and women, like the institution they served, were a culturally rich and diverse group representing more than 14 different denominations. The University of Pennsylvania was now truly poised to be able to unite two great educational missions in the bedside training of both the physician and the pastor toward the healing of their common patient and parishioner. 11. The Story Continues: 1992-1998The history through the previous paragraph was written by Dr. Jeff Stanley of the HUP Emergency Department while he was serving on the Professional Consultation Committee and helping to prepare for the 1992 re-accreditation by the ACPE. Dr. Stanley was an exceptionally compassionate and eloquent Emergency Room physician and a great ally of the Department of Pastoral Care. He left HUP in 1997 to be closer to his aging parents, but the Department owes him a debt of gratitude for his advocacy of Pastoral Care and his work in capturing the early history of our Department. The Development of the Department since 1992 came to outpace even the rather optimistic anticipations of Dr. Stanley. 12. Presbyterian Merger and the Development of the University of Pennsylvania Health SystemSince the early 1990s, the University of Pennsylvania Medical Center has become a national leader in developing a comprehensive health care system around an academic medical center. The Departments of Pastoral Care at the Presbyterian Medical Center and HUP had combined their CPE programs in 1995, and in 1996 the merger of HUP and Presbyterian became the first major step in creating the new Health System. The Department of Pastoral Care was one of the first fully merged departments of this new HUP-Presby jointure. The Health System moved toward acquiring 300 primary care practices in the three-state area, and formed a network of owned and affiliated hospitals and health care agencies called the University of Pennsylvania Health System. In 1998, the system included three core hospitals: HUP, Presbyterian Medical Center (merged in 1996) and Pennsylvania Hospital (the nation's oldest hospital, a 700-bed acute care hospital that was merged in 1997). Other affiliated hospitals spread from Shore Memorial Hospital in New Jersey to St. Luke's Hospital in Bethlehem Pennsylvania, and included Chester County Hospital, Chestnut Hill Hospital, Friend's Hospital (Psychiatric), Holy Redeemer Hospital, Phoenixville Hospital (which became UPHS-owned), and Wissahickon Hospice (also UPHS-owned). A plan to affiliate with Catholic Health Initiatives East brought another seven hospitals into relationship with the Health System in 1998. There was a strong tradition of CPE at Presbyterian Medical Center, which was for many years the flagship of CPE in the Philadelphia area. There was also a strong CPE program at St. Luke's Hospital in Bethlehem, and at Holy Redeemer Hospital, which was jointly accredited by the ACPE and the NACC. Beginning in 1996, a Pastoral Care network brought together representatives of the affiliated hospitals for quarterly meetings to consider our mutual commitment to Pastoral Care throughout the Health System and its affiliates. The goal of the Health System has been to provide a continuum of care from primary care through quaternary care on a regional basis, closely related to the research and teaching mission of the University of Pennsylvania Health System. 13. Evolution of CPEClinical Pastoral Education continued to be central to the mission and life of the Department of Pastoral Care. In 1997-98, over 60 units of Clinical Pastoral Education were conducted in programs of the Health System representing over 24,000 hours of supervised education in a rich variety of settings. These programs included ten full-time stipended residents in a shared program of HUP and Presbyterian, four full-time residents serving in NewCourtland Nursing Homes, and part-time extended units offered at HUP, Presby, NewCourtland, and Inglis House (a wheelchair community). In 1997-98, three students entered their second year of a supervisory education peer group. This program was augmented by a monthly supervisory education consortium organized in 1996 and included students and supervisors from St. Barnabas Health Care System in Tom's River, New Jersey, and supervisors from around the Philadelphia area. The Consortium was named after Daniel C. DeArment, Supervisor at the Presbyterian Medical Center from 1967 to 1992. Presbyterian Medical Center had a long history of CPE and supervisory education, and many certified supervisors throughout the association were Dan DeArment's students. During the period from 1992 to 1996, three ACPE supervisors were certified through the HUP/Presby Program: Joe Leggieri, who was certified in 1994, is now the Director of Pastoral Care and CPE Supervisor at Jefferson Medical Center in Philadelphia; Mary Carole Nelson, certified in 1994 and later became the Coordinator of Clinical Pastoral Education for the Health System, and Carl Yusavitz, certified in 1996 and later the Director of Pastoral Care and Supervisor at Easton Hospital. Aine Garvey who pursued supervisory education in this center during 1993-1995, was certified in the CPSP after additional work at Columbia Presbyterian in New York and went on to work with her religious community in Brazil. In addition to Chaplain Ciampa and Chaplain Nelson, two additional supervisors joined the Health System staff in these years: Robin Franklin in 1996 and George West in 1997. The department staffing was further strengthened by the addition of Community Liaison Chaplains, Rev. Ed Smith and Rev. David Henfield at HUP and Presbyterian, respectively. The role of Trauma Chaplain initiated by Sister Dorothy Ward was filled in 1994 by Sister Ramona Cecille. In 1997, Sr. Ramona expanded the Volunteer Pastoral Visitors Program, which had begun in 1993, to include over twenty faithful volunteers. Also, a grant from the Smart Family Foundation in 1994 enabled HUP to add a half-time Jewish chaplain, and that position was filled by Rabbi Debbi Pipe-Mazo until 1997, when Rabbi Rochelle Robins accepted that position after a brief interim served by Rabbi Shoshana Spergel (Larkey). In 1996 the department accepted a major contract with the Presbyterian Foundation for Philadelphia to provide Pastoral Care and Education through the NewCourtland Nursing Home System. Mary Carole Nelson accepted primary responsibility for this work and Rev. John Ehman, who had been in our CPE Program since 1994, was appointed Chief Chaplain and Department Site Manager at Presbyterian. 14. Community Clergy PartnershipThe period of 1992-1998 saw major growth in the partnership with community clergy, beginning with the first Annual Community Clergy Conference in 1992. This program focused on our trauma service and featured Dr. William Schwab, Chief of Trauma, and Dr. William Kelley, Dean of the School of Medicine and CEO of the Health System. Out of that program developed a mission statement for a Coalition of HUP with the Community Clergy and Churches. The Coalition built a strong record of Quarterly Community Clergy Luncheons, Annual Clergy Conferences featuring national preachers such as Dr. Jeremiah Wright and Dr. James Forbes, the Summer Youth Program, and the Clergy Community Health Information Program. In 1997, the Coalition was renamed the Interfaith Coalition with the University of Pennsylvania Health System, to recognize our commitment to partner with all segments of the religious community. A Parish Nurse Program was added to the partnership activities in 1998. A strong addictions awareness program and pastoral education for local denominational groups was also critical to the partnership. 15. Spirituality ResearchAn interdisciplinary spirituality research team was formed in 1996, with Dr. Barbara Ott from the Villanova University Nursing Program as a principal advisor. John Ehman, Chief Resident in the HUP CPE program at the time, completed a study investigating the preference of pulmonary patients regarding physician inquiry into their religious/spiritual convictions that might influence their treatment decisions in the event of grave illness. Chaplain Ehman was invited to present the findings to the National Conference of Chest Physicians in New Orleans, and to the National Society for Health and Human Values conference in Washington, in the Fall of 1997. Dr. Ott continued work as our Principal Investigator on a project to extend Chaplain Ehman's study to the nursing home setting at Care Pavilion in West Philadelphia, and to use focus groups to explore the reasons that African Americans complete Advanced Directives less frequently than the population at large. This project included funding for our first part-time research assistant, Denise Rivera. The Department became committed to continuing to develop these research opportunities with an interdisciplinary team that included a number of physicians and researchers throughout the Health System. 16. Spirituality Programs for the School of MedicineBeginning in the summers of 1996, the Department of Pastoral Care offered a six-week, full-time course in Spirituality and Medicine for five first-year medical students. Chaplain Ciampa, Dr. Horace DeLisser, Dr. Cindy MacNamara (1996), and Dr. Pam Cobbs (1997), co-directed a program drawing on the CPE model. In the Fall of 1997, as part of the new Humanism and Professionalism component of the School of Medicine's innovative Curriculum 2000, a three-hour symposium on Spirituality and Medicine was presented to the entire first-year class of the School of Medicine. 17. Future Directions from the Vantage Point of 1997Rich opportunities continued to open up to the Department of Pastoral Care in the areas of patient care, staff support, pastoral education, research, and community partnership. Documentation of all patient care visits became accomplished at HUP through a newly devised computer documentation system. A monthly ethics rounds program was developed with the Center for Bioethics. Pastoral Care took leadership in developing a Diversity Subcommittee of the Institutional Ethics Committee. And as noted earlier, a network that had formed with those responsible for pastoral care in other hospitals and agencies owned by or affiliated with the University of Pennsylvania Health System continue to develop. In November 1997, a web page was created by Pastoral Volunteer Vicky Maxon to link the Department of Pastoral Care to the Internet "community." This initiative aids the commitment to communicating with our CPE alumni/ae, to further the mutual benefit of our Health System's resources and the expertise and contacts of our growing alumni/ae community. In 1990, Chaplain Ehman took over the maintenance and additional development of the site. The Department of Pastoral Care continued to build on the foundation described by Dr. Stanley in 1992. A diverse group of staff, students, and volunteers found committed and creative partners in the Health System staff and leadership and in our surrounding interfaith community. The Department has striven to be faithful to its calling of pastoral care, education, research, and community partnership in this rich setting and in this challenging era. 18. 1998-2002The years of 1998-2001 were very eventful in the life of the University of Pennsylvania Health System and the Department of Pastoral Care. Changing health care economics, spurred largely by the Federal Balanced Budget Act of 1997—and the related reduction of Medicare payments to hospitals—resulted in financial losses for UPHS of over $200,000,000 in 1998-99. The Health System responded by laying off about 20% of the work force and enacting other austere savings strategies. The Department of Pastoral Care was able to weather these transitions without having to discontinue any ongoing CPE units and without having to eliminate any incumbent employees. However, CPE programming at Presbyterian was eliminated, and the Pastoral Care staff there was reduced to Chaplain John Ehman and part-time secretary Penny Andrews. These transitions coincided with the decision in 1999 by CPE Supervisor Robin Franklin to return to her native New York, and with the decision of CPE Supervisor Mary Carole Nelson to accept a position at Catholic Health Initiatives, which was dually accredited by ACPE and NACC, where she had been providing contract services from our Department to that affiliated system. In the spring of 2001, CPE Supervisor George West accepted the position of Director of Pastoral Care and CPE Supervisor at ANMED in Anderson, South Carolina. With contract hours from Mary Carole Nelson and Jack Gleason, CPE programming at Level I, Level II, and Supervisory Education continued through this period with 48 units of CPE reported in 2000-01. In the Fall of 2000, Supervisory Education Resident Steve Dutton achieved Associate Supervisor Certification and subsequently left a grant-funded position at Jefferson Hospital to join the staff at Wellspan Health System in York, Pennsylvania. Chaplain Dutton achieved full certification as a supervisor in 2002. Our first Community Liaison Chaplain, Rev. Edward L. Smith, Sr., was diagnosed with a brain tumor in the summer of 1999. During the period of Ed's declining health in February 1999, he graciously accepted our claiming him as our "Chaplain Emeritus" at the annual Gospelrama. Ed died in March 2000, and he is fondly remembered as an inspiration to our Department. The community activities launched by Chaplain Smith continued under the leadership of our Community Liaison Chaplain/Trauma Chaplain, Rev. David Henfield. Though in 1999 our funding for community activities was curtailed by the financial recovery program of the institution, our Coalition with the Interfaith Community was merged into an even broader coalition developed by our Department of Pastoral Care, the Office of the University Chaplain, Will Gipson, and the University Center for Community Partnership under Ira Harkavey. This new grant-funded initiative, the Program in Universities, Communities of Faith Schools and Neighborhood Organizations, has carried forward a creative range of community partnership activities with the Health System and the University. In 2000, the Congregational Nursing Program, which had been initiated by the UPHS Department of Nursing and the Department of Pastoral Care, utilized grant funding from the Pennsylvania Hospital First Hospital Foundation to transition the "ownership" of that program to the community partner with whom we had merged our Congregational Nursing Program in 1999: African American Interdenominational Ministries, Inc. Also in 2000, the NewCourtland Network of Long Term Care Facilities, sponsored by the Presbyterian Foundation for Philadelphia, shifted the contracted Pastoral Care and CPE programming, which had been developed by the Department of Pastoral Care in 1996, into a NewCourtland Pastoral Care program. At that time all of the CPE Residents and staff persons involved in our contracted program were offered employment opportunities with the NewCourtland Network. In 1998 the Department of Pastoral Care was named Research Center of the Year by the Association for Clinical Pastoral Education. An article published in the Archives of Internal Medicine (1999) by John Hansen-Flaschen, M.D., based on research by Chaplain John Ehman into patient preferences regarding physician inquiry into their spiritual/religious convictions, has now been cited in over two-dozen publications, and the research has been replicated at 4 other institutions. The Pastoral Care Research Committee has continued to meet regularly, carrying forward two research projects initiated in 1999, and it sponsored its fifth annual Symposium on Spirituality Research in March 2002. A monthly Penn Interest Group on Spirituality, Religion and Health, cosponsored by the Department of Pastoral Care and the Institute on Aging forms a network for continuing education and collaboration throughout the Health System, University and community. Summer 2001 marked the sixth offering of the summer elective for first-year medical students on Spirituality and Medicine, based on the CPE model. Physician Co-Director, Dr. Horace DeLisser initiated the program with Chaplain Ciampa, and Dr. Michael Baime has been the Co-Director since 1999. In partnership with Chaplain Al Lumpkin of Geisinger Medical Center and several other area supervisors, planning began in the Fall of 2001 to join with several CPE Centers in Eastern Pennsylvania to initiate a joint Supervisory Education Program in the fall of 2002. The ACPE Center of the UPHS Department of Pastoral Care successfully underwent its ten-year reaccreditation site visit in May 2002. A strong CPE Advisory Committee, under the leadership of our first non-Supervisor chairperson, Ted Madara, engaged in a very intensive Self-Study process beginning in January 2000. At the beginning of 2002 the Department of Pastoral Care is served by: Director Ralph Ciampa; Department Secretary Rita Haigh; Staff Chaplains Ramona Cecille, David Henfield, and Madeline Dawson; and Presbyterian Medical Center Chaplain John Ehman and Secretary Penny Andrews; Five Tier I Chaplain Residents and one stipended Tier II Supervisory Resident, three additional Supervisory Residents, nine part-time Chaplain Externs at HUP, five Chaplain Externs at Pennsylvania Hospital, twelve Volunteer Pastoral Visitors, seven Adjunct Chaplains, and several representatives of area faith groups, including Roman Catholic, Jewish, Islamic, and Jehovah's Witness representatives, who contribute to the 24-hour-a day, 7-day-a week Pastoral Care program that logs over 35,000 pastoral contacts per year. Strong collegial relationships with Chaplain James Luckey of Pennsylvania Hospital and Chaplain Jean Taylor at Phoenixville Hospital, and a satellite CPE arrangement with the Inglis House Wheelchair Community Department of Pastoral Care, directed by Keith Reed, provide valued partnerships for in Pastoral Care in the Health System. Also, the Research Program continues to benefit from the regular contribution of such generous associates as Tom Findley, M.D., Barbara Ott, Ph.D., R.N., and Horace DeLisser, M.D., who all serve as Principal Investigators on IRB-approved research projects with our department.
Throughout this period, the Department has been blessed by the strong and knowledgeable advocacy of Dr. Maureen McCausland, Chief Nursing Executive of the University of Pennsylvania Health System, through whom the Department reports administratively to the Health System. Through a time of major change, the theme of the Department of Pastoral Care, for its own life and for its message to the Health System and the community, remains the heartfelt wish of Chaplain Emeritus, Ed Smith:
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