Distinctives of Paediatric Hospital Chaplaincy

Kate Bradford
June 2015

Paediatric chaplaincy is not for everyone. It meets child-patients and families at times of greatest loses and needs. Nevertheless, for chaplains who have found their vocational home within Paediatric hospitals, few would swap their difficult privilege for any other ministry.

Is paediatric hospital chaplaincy different for any other form of chaplaincy? Are not all chaplains trained to minister to vulnerable people ─ suffering with loss and various major life issues? The first and major difference in paediatric chaplaincy is the differing, contradictory or even competing needs of the child-patient themselves and those needs of the child-patient’s family.

The UK NHS Chaplaincy Guidelines[1] highlight two areas that require specialised focus when working with children. The first area is concerned with the particular spiritual needs of younger people and children. This requires highly skilled and imaginative care. Related to this, and of paramount importance, will be ethical and safeguarding considerations for care in specialist paediatric units. Chaplains working in such areas will require enhanced training tailored to their context.

The second area of particular consideration is the concerns families and friends of younger people and children face which pose particular challenges to faith, belief and spirituality. Chaplains in paediatric settings will need to be equipped to support those facing these challenges and will require support and supervision.

Listed below are some ‘distinctives’ around paediatric chaplaincy:

1.       Children have different spiritual needs to adults; children and adolescents are at different development stages: physically, cognitively, emotionally and spiritually depending on their age and experience of life.

2.       Children have a greater vulnerability and require greater safeguards around their care.

3.        Paediatric chaplains very often visit parents and relatives who have been traumatically impacted by serious illness or disability of their child. In this case chaplains must ask, “Who is the actual patient?”

4.       Decisions are being made by parents, guardians, and medical staff on behalf of patients who cannot speak for themselves.

5.       There is heightened intensity around childhood illness triggering precipitation of anticipatory losses of hopes and dreams of the parents, family and wider community.

6.       Childhood illness, disability and death alter family systems forever, indelibly changing lives of siblings.

7.       When a young life does not reach its potential, there is a widespread belief that this is not fair and there are related issues of injustice, blame, guilt and shame.

8.       Our culture perceives serious childhood illness, disability and death as a ‘reversal of natural order’ and consequently does not cope well with these situations.

9.       There is a responsibility on all practitioners to be aware of self and the way in which their actions affect the plasticity of the family system.

Ministering as a chaplain in a paediatric environment does require an additional skill set, and not all generally trained chaplains will be equipped for ministry in a paediatric setting. The US Pediatric (sic) Chaplains Network has published a list of demonstrated competencies of a paediatric chaplain. [2] 

General competencies for a paediatric chaplain are knowledge, skills and maturity around self-awareness, theology, pastoral care, and leadership ability.

Chaplains in a paediatric setting will often find childhood memories triggered. These may be of the chaplain’s own childhood illnesses or disability but can also have to do with issues experienced second hand such as stillbirth, cot death, cancer, neglect, abuse, accidents or a myriad of other losses of hopes and dreams buried deep in the subconscious. These are psychological issues of transference, projection and countertransference that need to be addressed in order to understand whose needs are really being addressed in the pastoral situation; the child inside the chaplain, or the child in the hospital bed.

It is important that chaplains demonstrate emotional and mental stability. This stability is held together with the ability to relate to and connect with people over a wide range of ages and varieties of people. The chaplain also needs to display a non-anxious compassionate and kind presence in stressful situations, while being aware of, and maintaining clear professional boundaries.

Paediatric illness triggers a cultural outrage about the unfairness of innocent suffering; a God who could have prevented it; a notion that the pain of the loss of a child is pain unbearable, unendurable and to even speak of the possibility is to tempt fate.

A paediatric chaplain needs to have personally a well-integrated faith and practice that incorporates well-developed theological perspectives of suffering, prayer, forgiveness, religious faith, community and hope while remaining respectful of the vulnerability of the patient and family. In addition to working with positive aspects of faith the chaplain needs to be able to recognise issues of perceived absence of God, guilt, shame, blame, punishment, theodicies, and instances of distorted or destructive religious beliefs and practices.  When working with children and adults across a variety of ages, stages, faith and cultures it is important to have a working knowledge of stages of faith in order to communicate in the helpful categories, and to clarity issues around the difference between spirituality and religious faith systems. There needs to great clarity around the difference between responding to the patients’ needs and enquiries and proselytization which employs coercion.

Families are never a theological problem to be solved. They are complex evolving social systems and these systems function according to observed trends and patterns and when we apply spiritual intervention we also tweak the social systems. The maxim ‘to do no harm’ applies in spiritual care too.

A paediatric chaplain needs a good understanding of Family Systems and an acquaintance with Attachment Theory as well as various coping styles and grief models. Skills in active, attentive and reflective listening are equally significant. It is important for the chaplain to have the ability to differentiate the various needs of people in the system: the child-patient, parents, family, medical staff and the wider community.

In a paediatric setting compassion, empathy and kindness need to be accompanied by good leadership ability for time when advocacy is needed within a family system, the hospital setting, or the wider community. The chaplain needs to have the ability to develop training resources for church communities and in-services for the hospital community. Well rounded chaplaincy includes planning in conducting services of blessings as well as baptisms, funerals and memorials.

Chaplains care for child-patients and their families as they search for meaning, belonging and significance in the midst of illness and hospitalization. The chaplain accompanies families across a vast terrain of faith, love and hope, moving from immediate horizons out towards eternal horizons.

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[1] http://healthcarechaplains.org/news/documents/nhs_chaplaincy_guidelines_2014_v5.pdf accessed 28/6/15

[2] These are extensive and can be accessed at http://media.wix.com/ugd/bbe2bd_173f63d2cc994d3fb99895105a2ad943.pdf These competencies fall into four main categories: A. Self-knowledge and Personal maturity. B. Knowledge and Skills in Theology. C. Knowledge and Skills in Pastoral Care. D. Leadership Ability.