Emily Viverette

Viverette: This is the FaithHealth Learning Forum Podcast, a podcast series designed to offer insights into the vision of FaithHealthNC, a dynamic partnership between faith communities, Wake Forest Baptist Medical Center, and other healthcare providers focused on improving health. I am Emily Viverette, Director of FaithHealth Education. This particular series focuses on minding the wisdom of key leaders within the division of FaithHealth Ministries at Wake Forest Baptist Health.

Today, I’m talking with the Reverend Dr. Jay Foster, Director of FaithHealth Chaplaincy and Clinical Ministries. Jay is ordained Baptist. A board-certified Chaplin and certified educator. Jay was my CPE supervisor, a mentor, a colleague, and a friend. He was recently recruited to the position of Vice President of Spiritual Care Chaplaincy and Congregational Partnerships with Indiana University Health System. He’ll be leaving us soon, so I’m grateful to capture some of his wisdom before he does. So Jay, welcome.

Foster: Thank you. Good to be with you.

Viverette: You have been really integral to aligning spiritual care with FaithHealth across our whole system. I’m wondering if you’d say a little bit about what is chaplaincy and spiritual care? And then maybe how do you see it having changed over the past few years?

Foster: Thanks, Emily. Chaplains do lots of different things in the medical center and lots of caregivers, therapists, psychologists, providers of all kinds, attend to the emotional and spiritual needs of our patients. But what a chaplain does really is attend to issues of meaning and purpose in peoples lives. So if you’re admitted to a medical center like ours chances are you have a pretty significant illness and chances are your sense of meaning and purpose has impinged upon.

A chaplain is specially trained to work persons of all faiths or of no faith to be with them and listen to them as they work with issues of faith, concerns, and questions they have. It’s interesting. Some people during times of crisis like draw on their faith more closely. Others need to question their faith or push away. Some folks need to do both at the same time. A chaplain is trained to be that person to them. In the hospital that also looks like and some very specific ways, we’re there when someone is dying. We’re there when there’s a cold blue or a crisis. We’re there if somebody needs a meal. A family member comes in the hospital and they’re a long way from home and they don’t have enough to eat then we can provide a helping hand that way.

We’re there to help with things like educational and living wills and advance directives. Those kinds of things our hospital chaplain and hospital chaplains around the country have done for years and years and years. With the advent of FaithHealth about five ago years Gary Gunderson said something that was really wonderfully challenging to me.

At that time, I’d been a hospital chaplain for 25 years and I thought I’d knew something about it. And Gary made the very simple point that people come to the hospital for treatment but they go home to get well. For years and years and years as people left the hospital I gave them a card and I said if you need help finding a therapist, you need help finding a congregation, call me and I’ll help you with that.

In all the cards I gave out, I bet I got five phone calls. To build relationships with congregations ahead of discharge and give an actual name to somebody who goes out the door, that’s effective. So that’s how chaplaincy has changed during that time.

Let me speak to that in some specific programmatic ways. The first way that we tried to build this was through our residency program. And let me just say the metaphor that I have for how chaplaincy fits into the FaithHealth Network, the first metaphor I had of a hinge, but a trusted colleague said, “Well maybe a better metaphor than a hinge is a bridge.”

And so, the idea of a chaplain who has one foot firmly in a clinic and a bridge to a community resource outside that clinic. That was the idea. And we started with placing some our chaplaincy residents in particular clinics. So we started with the Downtown Health Plaza. DHP sees anybody who wants basic medical care, but they tend to see a lot folks who are Medicare/Medicaid or self-pay, but folks who are in need. They have one of the largest clinics of its kind in the state.

So we placed a resident there with a Care Plus team and that resident works with a team of physician, a social worker, a psychologist, to meet the spiritual needs of patients and make connections. So that chaplain had a foot here on the nephrology clinic inpatient, because lots of dialysis patients were also DHP. They tend to see the same person those two sets.

A second initiative of ours was one of our first staff chaplains. Speaking of the nephrology clinic, we hired a chaplain for transitional care to work with the Transitional Care team. We thought a really good idea would be to put that chaplain in our outpatient dialysis clinics because we know there are lots of healthcare disparities social determinants of health that show up in that setting.

So Diane Horton was hired in that job and worked for years in that setting. Didn’t turn out so good. She built lots of good relationships and she made lots of good connections with congregations who gave lots of material goods to the clinics, but it turns out that folks on dialysis are really emotionally ill and it turns out it’s a hard place to have a spiritual conversation because of the noise in the clinic. So it never grew in the way we really wanted. Diane was promoted to another position and I’ll say something more about that. So we took that idea of a chaplain for transitional care and hired Grayland Carlton to step into that role. If I could take a little aside, you asked how this was built, I think? How FaithHealth grew? Really one of the ways it’s grown in chaplaincy is we’ve followed the wisdom and strengths of the particular people who work with us and for us.

Well, Grayland, who’d been a chaplain resident for a couple of years prior to his residency, had spent five years working as the chaplain for The Gospel Rescue Mission downtown. He literally knew almost every person who was homeless in Winston-Salem. They’d all call him, “Hey Reverend Carlton!” So we hired Grayland as the transitional care chaplain, but instead of working with dialysis patients we aimed for persons who going through homelessness. His clinic was the Emergency Department and he would get called, especially by Emergency Department case managers but really by case managers throughout the hospital who needed to discharge a person who was homeless. He also had a foot with the Empowerment Project. So he was a member of that team. This is a team of case managers. It’s now managed by Dr. Teresa Cutts, who helps our division. Any rate, Grayland would learn that person’s need, help them connect with Empowerment Project or another case manager and follow them, provide spiritual care until they got to a place of stability. And there are lots of examples of persons who started out with Grayland like this and now have a job and an apartment and a life.

Viverette: I think that’s one of the really interesting things about this process… We get a lot of challenges on how this chaplaincy and how is this spiritual care? So how does that make sense to you? You’re directing all of this. There were some really clear lines a long time ago about what chaplains did and what they didn’t do.

Foster: So I’m going to speak really transparently to that because it’s still a work in progress in my mind. What happened is that Chaplin Carlton got promoted is now chaplain elsewhere in our system, and we’ve hired a new chaplain, Lenny Burrison, to step into that same role with homeless person. He’s doing a great job and Lenny and I were talking about just this the other day. Because some efforts are being made within FaithHealth to figure out well where do we set a boundary and when do we say no to someone. My response to Lenny was well, a major gift of the chaplain is to provide spiritual care. If we say no too early to a referral does that impinge upon that spiritual care conversation? Or is it our job to take all the referrals that come, provide spiritual care, and try to meet that referral and if we are not able to meet be able to say, I’m praying for you, I care for you, even though I can’t meet these social determinant needs?

That’s at least one way that I’m struggling with that boundary. What does a chaplain do that may be similar to but distinct what some of our other community engagement workers do?

Viverette: You know one of the things that you’ve often said that I still carry with me is the sense that it’s not our job to do everything, but if we can do something do it. That feels like one of the implicit mantras of this work. That there’s been ways we just let people go and not tended to them when we might have had access to other resources and spiritual care and faith communities that we never ever thought to tap into before.

Foster: I appreciate that. I was certainly taught by my first chaplain supervisor, it’s not our job to fix things it’s our job to be with people. I took that really to heart. Too much to heart. So just as I said to you, yeah, pay attention and be with people, but if can fix something, fix it.

Viverette: I know there are a lot of different pieces. I wonder if you take a few moments and just mention the first … there are two things I’d like to hear more about. One is the First Responder Chaplaincy Program. And then, you know we also these community hospitals where chaplains are heading up the ministry there and how do their roles look different than maybe some others in the country?

Foster: Great. Let me speak to the community chaplain thing first. So, in the last four years since I stepped into this role of directing the chaplaincy program, the institution has acquired or built now four community hospitals. And from the beginning it was a decision of the division and really of our leader Gary Gunderson, that it would be very good for chaplain to be the, in some ways, the face of FaithHealth in that community. So if the hospital president or the medical provider or a housekeeper needed to find out anything about FaithHealth, whether its CareNet counseling or spiritual care, community engagement. They only had to remember one person’s name and number to call and then the chaplain could help guide them to that person.

I think that’s really a brilliant idea. I also think for any chaplains out there listening that chaplaincy is going to grow and thrive in the next century, I think it’s going to be because we are able to really do this well. Where we provide spiritual care in the clinic and for persons who are really vulnerable help provide that resource in the community.

So our chaplains divide their time pretty evenly now between these community hospitals. About 50 percent of their time is devoted to spiritual care and about 50 percent of their time is devoted to community engagement. And what do I mean by community engagement? I mean finding those congregations and community resources in that county that meet needs and building referral networks and relationships that really connect in deep and true ways these wonderful resources that community for the needs of the hospital.

We recently had a strategic planning meeting for the department and what we decided, I think, is that we have a really good vision of why FaithHealth does the work we do, that is provide care for people that can’t afford it. We have a really good product reaching out to congregations who are really longing to do this work, where we need to spend some more time as developing the design, the how-to that connects those two and we’re getting there but that’s where some of the work is needed. I could say a lot more about that but in the interest of time let me also now speak to the First Responders Chaplaincy Program.

Viverette: And we do plan to interview Glenn Davis, who oversees that so he’ll tell us more but I think just a word might be helpful.

Foster: Good, so two quick words. The first is really to enter to say that would couldn’t have dreamed this up on our own. If we were sitting around the board room of Baptist Hospital thinking how would we do this, we would never come up with this. It’s rather Glenn’s unique gifts and his unique relationships across the county. Glenn was chaplain to the Forsythe County Sheriff’s Office for more than two decades and retired at the rank of Captain. That’s a pretty significant deal in the Sheriff’s Office world. He really had the trust of rank and file and leadership throughout the Sheriff office and throughout the county to do two things.

To go, persons, citizens, who were in need. Domestic violence issue, homicide, suicide, car accident and meet with family members and loved ones at the scene. And as importantly, maybe even more importantly, to provide spiritual care for those deputies for those EMTs, for the first responders, who were traumatized by what they witness.

So, as Glen reached retirement, he reached out to me and Gary and we were just sort of brainstorming what would it look like if that program were not housed at the Sheriff’s Office but housed here at the hospital. Why? Because all those traumas end up coming back here for treatment. Almost all of them. And to have that connection between the medical providers and therapist and all the resources of this big medical center here with a really tight connection with responders out there, what a brilliant way to do population health really? What a brilliant way to do community engagement? It has been so brilliant that while we started with the Sheriff’s Office last year Department of Social Services, the EMT Department, Public Health, all went to the County Manager and said we want some of that. We’d like a chaplain, please.

So, very recently the Director of Human Resources from the county, The Assistant Deputy Manager, and the County Manager sat down with Glen, Gary, and me to formalize an agreement to increase services. So now any Forsythe County employee whose experienced trauma can call upon Glen’s team, get a referral from Glen’s team so that they’re cared for right then. Right when they need it. Not 10 hours later. Not 20 hours later but right then because when you’re in trauma you need the help then not when doctors’ offices show up.

The chaplain will meet with that person then and make a referral to a physician, EAP, some other provider to help them through a longer road to recovery as that’s needed. You can tell I’m a little enthusiastic about that. We’ve now hired three persons to work with Glen. Dana Patrick, who’s a chaplain who trained here but then had two years of experience working with Buncombe County as their Wellness Coordinator for their DSS services. Aaron Eaton, who was the first resident to come through our program specifically for First Responder Chaplaincy and now another resident in that role Jesús Dominguez.

Viverette: Well, I don’t know we don’t have tons of time left and there are a million another questions we could ask. I do though want to hear… you’re about to head off to Indiana. I’m glad that I have your number on speed dial so I can call you when we need reminders of what it is that you have done for all these years. What are you going to be looking for as you head out to Indiana like … I think your title involves chaplaincy, spiritual care and congregational partnerships. As you take FaithHealth out there what’s it going to look like?

Foster: So really I hope to take two lessons from here. The first lesson is not sit in the boardroom and try to think out what’s the smartest, best way to do community engagement but really to follow the strengths and wisdom of the people already on that team.

So where is that chaplain already deeply embedded in some community that they’re not really to do and can I then help them rewrite their job description, their life in a way that let’s actualize a part of their ministry that would help that community and that chaplain?

The second thing I hope to do is to get out and really learn those congregations. Indianapolis is a pretty big city and they have significant urban issues. Eleven of the 16 hospitals in the IU system are in very small rural communities. They’re going to have very different needs.

So my first year or two is really going to be learning what are the needs and rich resources of each of those hospitals? What are the congregations that are already in their backyard wanting to partner but haven’t been invited yet? Big picture, I’ve got an idea. It will be really interesting to see what it looks like in real time.

And I’ve got your number on speed dial, as well.

Viverette: It’s been one of the great pieces of wisdom that Gary Gunderson brought here is that we can look into a community and see all sorts of needs but really where we are going to have the most capacity to build and make connections is out of the strengths and resources. So, it changes the whole outlook of community and programs and medical centers when you start looking from kind of the resources’ strength lens and that’s just been a real gift to me as have you. So thank you. Thanks for the conversation.

Foster: Thank you so much, Emily. Cheers.