Development of Spiritual Care Services in Israel

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

In 2007, a major new funding initiative was launched for the development and provision of spiritual care services and training programs in Israel. During three years ten programs were developed. This impressive development was considered important and of unique contribution to patients. At the same time the services face challenges in growth and implementation.

Purpose of health policy or idea

The Jewish Federation of New York launched a major new funding initiative for the development and provision of spiritual care services and training programs in Israel. Prior to this initiative, the field of spiritual care for patients was virtually unknown in Israel; no training programs were being offered and there were no formal frameworks offering services, with the exception of very limited and sporadic efforts. The initiative arose from the recognition of the value of incorporating spiritual care into the health care services for vulnerable populations, such as the elderly and those facing illness, trauma and bereavement, in order to provide a more comprehensive and holistic response to their needs. Altogether, between 2006 to 2008 about ten programs were developed and an evaluation of those programs was conducted.

Spiritual care is about supporting individuals and helping them maintain their personal identity in a threatening situation. Its purpose is to create hope in situations of distress and loss and to produce meaningful relationships and experiences. This is particularly apparent in medical settings that usually disregard these existential components of illness and focus only on its physical aspects. Spiritual care is necessary because everyone, whether religious or not, needs support systems, especially in times of crisis. Therefore, spiritual care in the medical context is provided to people with serious illnesses. Its goal is to help sick people achieve moments of peacefulness and acceptance, while contending with illness and facing death. Spiritual care (or chaplaincy, as it is known in the USA and Canada) is a completely person-centered form of care; it makes no assumptions about personal convictions or life orientation and is not necessarily religiously oriented. Spiritual care provides the potential for shared existential connections and meeting places among the sheer vibrancy and diversity of Israeli society.

Main points

Main objectives

The main objective for the development of the services was the wish to incorporate spiritual care into the services that vulnerable populations already receive, in order to improve the quality of care and to provide a more comprehensive and holistic response to their need.

Characteristics of the instrument: Three of the programs offer intensive training courses for professional spiritual care providers. Seven programs provide short in-service training and education in spiritual care for health and social service professionals, as well as spiritual care services, retreats and seminars to patients, family members, terror victims and the general public.

Type of incentives

The programs do not include financial incentives, but rely on a belief in the importance of these services.  

Groups affected

Terminal patients and their family caregivers, the elderly and other vulnerable population groups receiving spiritual care for relief of suffering and helping them through difficulties, geriatric and palliative care services that benefit from the support provided by the spiritual care services, health and social services that benefit from having access to tools to better support vulnerable and suffering patients and family members.

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Spiritual support services are without a doubt a new concept in Israel, which has been very well received by policy-makers, administrators and therapists. However, the demand for the service is currently among those who have been exposed to it, while many others still do not know about it. Undoubtedly, the service is still in an early stage and there is a need for many additional services so that it becomes a national service. Since the focus of the developing services in Israel is the Jewish Israel population, it appears that at this stage it is not suitable to transfer it to other systems.

Political and economic background

The development of the spiritual care services was not government driven and it did not attain a governmental goal. 

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

The spiritual care services were launched in 2007 by the Jewish Federation of New York and were also funded by them. This was an entirely new approach in the Israeli healthcare system. Without the initiation, the drive and the money provided by the Federation, these services would probably not have been generated. The aim for the development and provision of these services was to expand the recognition of the value of spiritual care for vulnerable population groups, and to convince stakeholders of their benefit in order to incorporate spiritual care services into the healthcare system in Israel. The Federation wanted to develop spiritual care in Israel, having seen how beneficial it has been in the United States; they also wanted to develop the Jewish aspect of spiritual care.

In 2006, the Federation began with developing ten programs in general hospitals, long-term geriatric institutions, psychological clinics, centers for trauma victims, day-care centers for addiction, and palliative care and other services in the community. They believed that the most appropriate way is a grass-roots development of spiritual care (meaning bottom-up approach). The idea was to create the need for spiritual care in many services so that the various government agencies will have to formally recognize the field. It is unlikely that these government agencies will take action on spiritual care until it is shown to be a useful part of the system.

Initiators of idea/main actors

• Government

• Providers

• Patients, Consumers

• Scientific Community

• International Organisations

Approach of idea

The approach of the idea is described as:
new: Prior to this development, spiritual care services were almost unknown in Israel.

Innovation or pilot project

Pilot project - Spiritual care programs were developed in in-patient and out-patient health services that had never offered them before.

Stakeholder positions

Most of the stakeholders and policy-makers in the Israeli healthcare system are unfamiliar with spiritual care. They expressed lack of knowledge and understanding about spiritual care and confusion over the difference between spiritual and religious services. They were concerned about how health and social service professionals would relate to spiritual care providers and said that it is a challenge to introduce new ideas and programs into Israel's healthcare services. On the other hand, hospitals and community services that had the good fortune to receive a new service without having to invest financial resources were very satisfied and would be happy to expand the service.

Hospitals, nursing homes and community services benefitted from a new service, in which they did not need to invest resources. Staff also received training in this new field with no further expense. Oncology and palliative patients, and drug and terror victims receive a new service which helps them to deal with their problems.

Actors and positions

Government
Ministry of Social Services	very supportive		strongly opposed
Ministry of Health	very supportive		strongly opposed
Providers
General hospital	very supportive		strongly opposed
Nursing homes	very supportive		strongly opposed
Health funds	very supportive		strongly opposed
Patients, Consumers
Terminal patients	very supportive		strongly opposed
Chronic patients	very supportive		strongly opposed
Family caregivers	very supportive		strongly opposed
Drug addicts	very supportive		strongly opposed
Terror victims	very supportive		strongly opposed
Scientific Community
Researchers and academic professionals	very supportive		strongly opposed
International Organisations
Jewish Federation of New York	very supportive		strongly opposed

Influences in policy making and legislation

It is too early to discuss any legislative process and any initiative to include spiritual care in the health benefit basket of services.

Actors and influence

Government
Ministry of Social Services	very strong		none
Ministry of Health	very strong		none
Providers
General hospital	very strong		none
Nursing homes	very strong		none
Health funds	very strong		none
Patients, Consumers
Terminal patients	very strong		none
Chronic patients	very strong		none
Family caregivers	very strong		none
Drug addicts	very strong		none
Terror victims	very strong		none
Scientific Community
Researchers and academic professionals	very strong		none
International Organisations
Jewish Federation of New York	very strong		none

Positions and Influences at a glance

Adoption and implementation

The main concerns of many stakeholders and directors in the Ministry of Health and in the Ministy of Social Services were about funding and the competition for limited resources. Most of the stakeholders and executives believe that the discipline has to evolve gradually, starting with the service providers, i.e. a bottom-up approach. Once sufficient momentum has been achieved, the health and social service policy-makers can become fully involved. They think that it is important to continue the current funding for programs of this kind and to use them as a catalyst to inspire greater interest within the wider community and for recognition of the important role of spiritual care within the health and social services.

Ten programs currently provide spiritual care and training courses. Three of them offer intensive training courses for individuals aspiring to become professional spiritual care providers, five provide in-service training and education in spiritual care for health and social service professionals, and two offer short in-service training to health professionals and the general public, as well as conferences, retreats, and seminars.

Monitoring and evaluation

In 2008, the Brookdale Institute was asked to provide an in-depth, systematic overview of the current status of implementation of spiritual care programs and their development over the last three years. In addition, it was asked to explore the short- and long-term future needs and directions of this new discipline, and to identify current opportunities and challenges in order to better plan and promote the services.

The research report, which was submitted to the Federation of New York in 2010, provided an in-depth, systematic overview of the development over the last three years and the current status of the spiritual care programs. Further, it explored their short- and long-term future directions and identified current opportunities and challenges in order to better plan and promote spiritual care in Israel. The study examined the types and the extent of spiritual care training and service programs, the experiences of patients, family and staff, and the attitudes of stakeholders and policy-makers towards spiritual care.

To this end, over 80 in-depth interviews and discussions were held with senior officials in government ministries, directors and leaders of training and service programs, hospitals and nursing institutions, graduates of the educational programs and patients and family members who have received spiritual care services. Also, senior executives of spiritual care and palliative organizations from Israel and the United States were interviewed.

The findings of the study indicated that the training programs are very successful, but that they face challenges in the implementation and in finding placements for their graduates. The findings also indicate the impressive development that took place in this field in recent years and the great appreciation for, and importance ascribed to, spiritual care and its unique contribution to patients.

The report serves as a basis for the continued development of spiritual care programs in Israel. The findings of the study were presented to senior representatives of the UJA-Federation of New York and have served as a platform for extensive discussions on their continuing role in developing spiritual care in Israel. In addition, the findings were presented to many forums in Israel, including senior officials of the Ministry of Health and key personnel in palliative services.

Review mechanisms

Final evaluation (external)

Dimensions of evaluation

Structure, Process, Outcome

Results of evaluation

There has been a remarkable growth of spiritual care programs in Israel within a very short period of time. In just three years, thousands of individuals, professionals and recipients of care have been exposed to the spiritual care framework. Among the directors of programs and institutions, and the recipients of spiritual care, there is a genuine excitement about the potential value and impact of spiritual care. It is clear that for the people currently involved, spiritual care has so far been implemented in an appropriate manner that fits within the Israeli social context.

Spiritual care has begun to establish roots within the health and social service system in Israel, but it is still at an early stage of development. The implementation process needs to continue fast, with care and consideration about the best way for spiritual care to be accepted by the health and social services establishment. We have set out some ideas to facilitate further implementation of spiritual care and to build on the impressive start that has already been made.  

The report proposes a framework for the future development of spiritual care in Israel. Two basic approaches for implementing spiritual care and integrating it more fully into Israel's social and healthcare systems were proposed: Consolidating and professionalizing the profession in Israel, and broadening the scope of spiritual care, so that stakeholders become familiar and comfortable with the idea.

The initial foray into spiritual care - through individual care, conferences, seminars, and workshops - has introduced thousands of people, both professionals and recipients of care, to a virtually unknown field. This rapid exposure of the Israeli society to spiritual care has been mostly due to the involvement of a few deeply committed enthusiasts and to the funding they have received. These individuals are trained in a wide range of disciplines, with therapeutic experience and knowledge. However, none of them is formally trained in spiritual care. There are currently no fully accredited spiritual care training programs in Israel, but the consensus for the need of such programs is growing.

The first major theme drawn from the evaluation is that of developing and consolidating spiritual care programs that not only allow for the expansion of spiritual care provision, but also lead to official recognition from various government agencies. Such a process needs to be accelerated so that spiritual care can be an automatically included service in the health and social system in Israel. The second related theme is the continued exposure of spiritual care to directors, policy-makers, and stakeholders in health and social services in Israel. Based on the evaluation of spiritual care services, several potential directions have been identified, within the context of these two themes, for the future development of spiritual care provision: Establishing spiritual care as a profession in Israel, and development and implementation of a system of placement and supervision of spiritual care providers. Short-term approaches were suggested in order to increase the number of recognized (and officially certified) spiritual care providers and to develop a higher public profile for spiritual care and ecognition by government agencies.

Expected outcome

The development of spiritual care in Israel came at the right time and fits in well with the current Israeli zeitgeist for the existential and spiritual dimensions. However, despite the development of services and the enthusiasm of the implementors, their scope is yet limited, and their status is not fully established. Moreover, many services are offered in the center of Israel, particularly in Jerusalem, and very few services are offered in the more distant peripheral areas. Further, they are not yet culturally sensitive to minority groups, such as immigrants from the former Soviet Union, Ethiopia, etc. There is hope that the enthusiasm and faith of the program developers will carry the services further, to obtain government funding in addition to the philanthropic fund, and to expand the services.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

Spiritual support services improve the quality of care for people in stressful situations and they were highly appreciated. However, only a small percentage of the people who need the services receive them, because of their limited scope. It is advisable to expand the services so that all population groups have the opportunity to access these services.

References

Sources of Information

• Bentur N, Resnizky S and Sterne A. Attitudes of stakeholders and policymakers in the healthcare system towards the provision of spiritual care in Israel. Health Policy  2010; 96 (1):13-19
• Bentur N and Resnizky S. Challenges and Achievements in the Development of Spiritual-Care Training and Implementation in Israel. Palliative Medicine 2010; Forthcoming

Author/s and/or contributors to this survey

Netta Bentur

Prof. Bentur is a Senior Researcher at Myers-JDC-Brookdale Insitute and an Associate Professor at Tel Aviv University

Suggested citation for this online article

Netta Bentur. "Development of Spiritual Care Services in Israel". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/is/a16/2