Factors Associated with Receiving Chaplaincy Care: - Findings from a Study of Patients with TBI

1. Factors Associated with Receiving Chaplaincy Care: -Findings from a Study of Patients with TBI George Fitchett, D.Min., Ph.D. Department of Religion, Health & Human Values george_fitchett@rush.edu James Risk, MDiv, BCC Executive Director (retired) Bishop Anderson House Hendrik Hutagaol, MA, BCC Chaplain Loma Linda University Medical Center

2. Outline • Framing our Research • Sneak Preview • Study Methods • Study Findings • Discussion • Future Research • form rehab research collaborative

3. Objectives At the conclusion of this activity: Participants will be able to critically reflect on the factors that shape which patients receive spiritual care and how much care they receive. Participants will be able to critically describe an instrument that was developed to collect data about the type and amount of chaplain care in 3 different institutions. Participants will be able to describe what is required to develop objective indicators for spiritual care in diverse clinical contexts, including acute rehabilitation. No conflicts to declare

4. Framing Our Research What information do you have, would you like to have, to answer these questions? 1. You are a spiritual care department manager. Your institution is about to acquire a 35 bed medical rehabilitation facility that has had no spiritual care. Your administrator asks you what level of chaplaincy staffing will be needed. What do you tell her?

5. Framing Our Research What information do you have, would you like to have, to answer these questions? 2. A new director of OT has come to your acute rehab unit and wants you to do an in-service on when OTs should make referrals to the chaplain. What do you tell them?

6. Framing Our Research What information do you have, would you like to have, to answer these questions? 3. You are the chaplain for your 25-bed acute medical rehab unit. You also cover 3 general med/surg units with a total of 90 beds. How do you decide which patients to see in each of these areas?

7. Sneak Preview – What We Found • There was wide variation, across the 3 institutions in: • percent of patients who received any chaplain care and, • among those who received any chaplain care, the amount of chaplain care they received. • Essentially none of the variables we tested (demographic, medical, psychological, religious) were consistent predictors of receiving any chaplain care or of the amount of chaplain care received.

8. Parent Study Improving Outcomes in Acute Rehabilitation for TBI Using Practice-Based Evidence (PBE) Susan Horn, PhD, PI, International Severity Information Systems, Salt Lake City (presently University of Utah School of Medicine) John D. Corrigan, PhD, Co-PI Ohio State University PBE is an alternative to RCTs for determining effectiveness of interventions.

9. Parent Study: Aims Aim 1:Identify patient characteristics (demographic, medical) that explain variation in the outcomes of acute rehabilitation for TBI. Aim 2:Identify specific procedures and interventions that are associated with better outcomes, controlling for patient characteristics. Aim 3:Determine whether specific impairment-by-treatment interactions are associated with better outcomes.

10. Parent Study: Method Study Variables • Patient characteristic variables • Severity of the TBI and other medical conditions, demographics and psychosocial background • Process variables • All rehabilitation interventions (therapy, medical interventions, patient education, counseling, and activities involving all disciplines) • Outcome variables • Functional independence, length of stay, and discharge location Data Sources: • Medical record • Patient characteristics and medical procedures • Point-of-care documentation

11. Multi-Center Study N=2130 patients enrolled from October 2008 to September 2011

12. Chaplain Sub-Study: Aims Aim 1. To describe the spiritual care provided by the chaplains to the TBI patients in this study. Our goal in this aim was to describe the type and extent of the chaplains’ spiritual care for these patients and to explore a number of factors that might be associated with variations in the care that was provided. Aim 2. To examine the effect of chaplain care on patient outcomes.

13. Chaplain POC Form

14. Chaplain POC Form

15. Study Participants

16. Study Participants

17. Study Participants

18. Who Receives Chaplain Care

19. Received Any Chaplain Care Models adjusted for all variables listed

20. Minutes of Care Received

21. Discussion • What about the variations in chaplain care? 2. What about no variables consistently predicting chaplain care? 3. Limitations • Possible unmeasured predictors of chaplain care • Other limitations

22. Advancing EB Screening & Assessment • Research about spiritual needs can inform the development of EB models for screening and referrals for spiritual care • This will increase the likelihood that patients who need spiritual care are offered the opportunity to receive it • Form a rehab research collaborative?

23. Acknowledgments Parent study funding: NIH Chaplain sub-study funding: Bishop Anderson House Susan Horn, PhD (PI parent study), University of Utah School of Medicine Erin Emery-Tiburcio, PhD, Rush Medical Center Jim Huth, PhD, BCC, Sunnybrook Veterans Centre, Toronto

24. Bibliography • Archives of Physical Medicine and Rehabilitation Vol 96, No 8, August 2015, Supplement 3 (special issue of reports on the parent study) • Horn SD, Corrigan JD, Bogner J, Hammond FM, Seel RT, Smout RJ, Barrett RS, Dijkers MP, Whiteneck GG. Traumatic Brain Injury-Practice Based Evidence Study: Design and Patients, Centers, Treatments, and Outcomes. Arch Phys Med Rehabil. 2015 Aug;96(8 Suppl):S178-96.e15.