The Role of the Advance Care Planning Facilitator
The advance care planning (ACP) Facilitator is an emerging role in healthcare. ACP Facilitators are instrumental in helping individuals, their families, and their loved ones become more engaged in person-centered decision making. If ACP conversations were easy, they would be more commonplace than they are today.
The role of the ACP Facilitator is a critical component to achieving the ACP desired outcome—to know and honor an individual’s informed healthcare decisions.
Because ACP is not a one-size-fits-all conversation, ACP Facilitators must be trained to have conversations with individuals at different stages of health and in different settings of care. ACP Facilitators add value to an organization and community and are central to any program’s success.
The value of the Facilitator role is demonstrated through:
- Timely and appropriate referrals for ACP services,
- The person-centered decisions individuals and families are assisted in making,
- The overwhelmingly positive individual and family satisfaction with this role, and
- Professional competence and confidence in providing skilled facilitation and delivering care that is consistent with an individual’s goals, values, and beliefs.
RC ACP Facilitator Certification
First Steps® ACP Facilitator Certification
The First Steps® (FS) ACP Facilitator Certification course is designed to help participants learn the skills needed to facilitate foundational ACP discussions with any adult.
Target Audience
FS ACP Facilitator Certification is intended for healthcare providers (nurses, all levels of social workers, health educators, and physicians), clergy, and others involved in providing ACP facilitation.
Purpose
The purpose of this program is to assist participants in learning effective communication and interview skills for person-centered ACP facilitation.
Objectives
- Identify interview skills for facilitating FS conversations with healthy adults.
- Identify interview skills for facilitating FS for adults with chronic illness.
- Create strategies to communicate the plan, including the completion of an advance directive document.
- Examine the ACP Facilitator’s role in implementing 3 key systems for ACP effectiveness.
- Demonstrate beginning competency in facilitating FS conversations through role-play activities.
Initial Certification Requirements
- Completion of the FS ACP Facilitator Certification Online Curriculum (Modules 1-4)
- Completion of the FS ACP Facilitator Certification classroom training (8-hour classroom instruction)
Ongoing Certification Requirements
Currently, RC has no ongoing recertification requirements. It is recommended that recertification requirements be established and monitored by the Facilitator’s sponsoring organization and RC Instructors. RC intends to establish recertification requirements in the future.
Next Steps ACP Facilitator Certification
Next Steps (NS) ACP is offered to patients when chronic illness becomes more advanced—when clinical triggers arise, such as complications, frequent hospitalizations/clinical encounters, or a decline in function. For a patient with heart failure, it may be a heart attack, pulmonary complications, or increased symptoms during daily living activities.
Target Audience
The RC NS ACP Facilitator Certification course is intended for qualified professionals to learn communication techniques to facilitate an in-depth, disease-specific ACP interview. This stage of ACP is focused on individuals with chronic, progressive illness who are beginning to experience a decline in health and/or complications. They may also need assistance making more specific treatment decisions based on their unique illness and its corresponding trajectory.
Initial Certification Requirements
Certification is only available through contracted implementation of the NS ACP program and not offered as an RC national course.
- Completion of the NS ACP Facilitator Certification Online Curriculum (Modules 1-4 and Module 6)
- Completion of the NS ACP Facilitator Certification classroom training (16-hour classroom instruction)
- Review of NS ACP Facilitator Manual
- Demonstration of competency in delivering the NS ACP Interview
Ongoing Certification Requirements
Currently, RC has no ongoing recertification requirements. It is recommended that recertification requirements be established and monitored by the Facilitator’s sponsoring organization and RC Instructors. RC intends to establish recertification requirements in the future.
Last Steps® ACP Facilitator Certification
Last Steps® (LS) ACP is initiated as a component of quality end-of-life care for frail elders and those whose death in the next 12 months would not be unexpected. The LS planning conversation is focused on goals of care to make timely, proactive, and specific end-of-life decisions. Ideally, these decisions are converted into medical orders that can be followed throughout the continuum of care. The
Physician Orders for Life-Sustaining Treatment (POLST) program is the nationally recognized model for this stage of planning.
Target Audience
The LS ACP Facilitator Certification course is intended for healthcare clinicians (nurses, social workers, chaplains, physicians) and others involved in assisting those with serious illness or frailty in making treatment decisions based on their goals of care.
Purpose
The purpose of this program is to improve the effectiveness of the LS ACP (a POLST Paradigm program) through facilitation skills training.
Objectives
- Describe the goals of LS, a POLST Paradigm program.
- Identify interview skills for facilitating LS conversations.
- Identify skills to assist individuals in making informed treatment decisions that include CPR, limitations on treatment, and comfort care.
- Develop strategies to create a POLST form that accurately reflects an individual’s treatment preferences.
- Identify systems to honor the POLST plan.
- Demonstrate beginning competency in facilitating LS conversations through role-play activities.
Initial Certification Requirements
- Completion of the LS ACP Facilitator Certification Online Curriculum (Modules 1-4 and Module 5)
- Completion of the LS ACP Facilitator Certification classroom training (8-hour classroom instruction)
Ongoing Certification Requirements
Currently, RC has no recertification requirements. It is recommended that recertification requirements be established and monitored by the Facilitator’s sponsoring organization and RC Instructors. RC intends to establish recertification requirements in the future.
The RC Facilitator Certification course may be provided:
- By RC within an implementation agreement (FS, NS, and LS);
- By RC Organization Faculty (OF) (FS, NS, and LS); or
- By attending an RC national course (FS and LS).
I had been leading group facilitations and met a woman (“Jane”) who signed up for a follow-up one-on-one facilitation. I encourage individuals to bring their families as they can also hear their adult children’s wishes. Jane brought her husband and two adult sons.
When you walked in the room you could immediately feel that three of them didn’t really want to be there. Jane commented, “Everyone is doing this as my Mother’s Day present.” I noticed that one of the two sons (“Joe”) was in a wheelchair and I thought to myself that his situation might make for a richer discussion during the exploration of experiences with illnesses and injuries. However, when asked, no one volunteered any experiences.
I really relied on my Facilitator training and called out the elephant in the room. I asked the son, “I see you are in a wheelchair. Were you in an accident?” Everyone was silent. He responded that he had tried to commit suicide. Jane said that they had never talked about it before. I asked them if they were comfortable talking about it now.
What an honor and a gift we are giving this family to create a safe environment for conversation. Jane shared how scared she had been and how they wanted to do everything to help Joe. Tears were rolling down Joe’s face to hear his mom talk about how scared she was.
Jane’s family came in apprehensive and left grateful. Jane was so thankful for the conversation; she hugged me on her way out and later sent me a thank you note. As a Facilitator, what a gift to be invited into these family’s homes.
It is just so amazing. Each conversation is so different and so powerful.
Jennifer Tiedemann, First Steps® ACP Facilitator
Stages of Planning
First Steps® (FS) is appropriate for any healthy adult over the age of 18 or who may have a chronic illness but has never prepared an advance care plan. The goals of this stage are to motivate patients to plan, assist in selecting a qualified healthcare agent/decision maker, provide instructions for goals of care in the event of a permanent and severe neurologic injury, and complete a basic document.
Next Steps (NS) is offered to patients when chronic illness becomes more advanced—when clinical triggers arise, such as complications, frequent hospitalizations/clinical encounters, or a decline in function. For a patient with heart failure, it may be a heart attack, pulmonary complications, or increased symptoms during daily living activities.
Last Steps® (LS) is initiated as a component of quality end-of-life care for frail elders and those whose death in the next 12 months would not be unexpected. The LS planning conversation is focused on goals of care to make timely, proactive, and specific end-of-life decisions. Ideally, these decisions are converted into medical orders that can be followed throughout the continuum of care. The Physician Orders for Life-Sustaining Treatment (POLST) program is the nationally recognized model for this stage of planning.
