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.
Respecting Choices ACP Facilitator Certification
Advance care planning provides the “knowing” part of “knowing and honoring” required for person-centered decision making. The Respecting Choices ACP Facilitator Certification standardized curriculum has been tested for over 25 years. The goals of this standardized approach to Facilitator certification are to:
- Certify individuals in a competency-based approach to ACP facilitation.
- Ensure the delivery of a consistent and reliable ACP service.
Respecting Choices has adopted a philosophy called “flexibility within a framework” where core elements learned are critical to person-centered conversations (the ”framework”) with the ability to adapt how each phase of the conversation proceeds specific to each individual/patient (the “flexibility”).
The ACP Facilitator Certification curriculum is designed to accelerate the process for those who intend to become certified in more than one stage of planning. By building on the skills learned in one ACP Facilitator Certification course, participants can focus on acquiring the knowledge and skills to be agile and critically think how to seamlessly serve individuals where they are at in their disease.
ACP Core Component Course
The ACP Core Component course focuses on learning the communication skills and the Exploration phase of facilitating conversations with all individuals. It lays the groundwork for using that information to align healthcare decisions with what matters most when carried forward to the Goals of Care phase of the ACP conversation to support person-centered decision making. The ACP Core Component course affords an in-depth experience for course participants in exploring the individual’s goals, values, and beliefs when having an ACP conversation. The Exploration phase of facilitated conversations is where “flexibility within a framework” really comes in.
Target Audience
The ACP Core Component course is intended for professionals and healthcare providers (social workers, nurses, health educators, and physicians), clergy, volunteers, and others involved in providing ACP facilitation.
Purpose
The purpose of this course is to assist participants in learning effective communication and conversation skills and techniques for facilitating person-centered conversations. These conversations have application for in-person visits and telehealth.
This course is a prerequisite for attendance at First Steps, Next Steps, and Advanced Steps ACP Facilitator Certification Intensive courses.
Course content level: Intermediate for social workers.
Learning Outcomes
At the end of the course, the participant will be able to:
- Identify intended populations for ACP conversations.
- Verbalize strategies to engage individuals and healthcare agents in ACP.
- Demonstrate communication skills to promote person-centered ACP conversations.
- Apply critical thinking to discern what matters most to individuals.
Initial Certification Requirements
- Completion of Respecting Choices First Steps ACP Facilitator Certification Online Curriculum (Modules 1-4)
View Upcoming Respecting Choices National Courses
First Steps® ACP Facilitator Certification
The First Steps® ACP Facilitator Certification course is designed to help participants learn the skills needed to facilitate foundational ACP conversations with individuals who are healthy or have early chronic illness.
Target Audience
First Steps ACP Facilitator Certification course is intended for a variety of professionals (social workers, nurses, health educators, physicians, clergy, and other care providers) and community volunteers. This course is appropriate for all levels of knowledge.
Purpose
The purpose of this course is to assist participants in applying effective communication and conversation skills and critical thinking for person-centered ACP facilitation. These conversations have application for in-person visits and telehealth.
Course content level: Intermediate for social workers.
Learning Outcomes
At the end of this course, the participant will be able to:
- Define benefits of (stage-specific) ACP conversations and identify appropriate target population.
- Demonstrate the application of the person-centered decision-making framework to elicit preferences and decisions.
- Create strategies to transfer individual goals, values, and preferences to a written plan, e.g., advance directive.
- Demonstrate beginning competency in facilitating First Steps ACP conversations through role-play exercises.
Initial Certification Requirements
- Attend the ACP Core Component course.
- Completion of Respecting Choices First Steps ACP Facilitator Certification Online Curriculum (Modules 1-4)
- Completion of the First Steps ACP Facilitator Certification course (In-person classroom learning or Live distance learning webinar/virtual learning environment)
View Upcoming Respecting Choices National Courses
Next Steps ACP Facilitator Certification
The Next Steps ACP Facilitator Certification course is designed to help participants learn the skills needed to facilitate ACP conversations with individuals with serious illness who have potential for complications This stage of ACP is focused on individuals with chronic, progressive illness who are beginning to experience a decline in health and/or complications and/or more frequent clinical encounters They may also need assistance making more specific treatment decisions based on their unique illness and its corresponding trajectory. These conversations have application for in-person visits and telehealth and strengthens care coordination.
Target Audience
Next Steps ACP Facilitator Certification course is intended for qualified healthcare professionals (nurses, social workers, chaplains, physicians, advanced practitioners) and other care providers.
Purpose
The purpose of this course is to assist participants in applying effective communication and conversation skills and critical thinking for facilitating person-centered for those living with serious medical conditions that may result in complications with unacceptable outcome(s). These conversations have application for in-person visits and telehealth.
Course content level: Intermediate for social workers.
Learning Outcomes
At the end of this course, the participant will be able to:
- Define benefits of (stage-specific) ACP conversations and identify appropriate target population.
- Demonstrate the application of the person-centered decision-making framework to elicit preferences and decisions.
- Create strategies to transfer individual goals, values, and preferences to a written plan, e.g., advance directive.
- Demonstrate beginning competency in facilitating Next Steps ACP conversations through role-play exercises.
Initial Certification Requirements
- Attend the ACP Core Component course.
- Completion of the Next Steps ACP Facilitator Certification Online Curriculum (Modules 1-6)
- Completion of the Next Steps ACP Facilitator Certification course ( In-person classroom learning or Live distance learning webinar/virtual learning environment)
View Upcoming Respecting Choices National Courses
Advanced Steps ACP Facilitator Certification
The Advanced Steps (AS) ACP Facilitator Certification course is designed to assist participants learn the skills needed to facilitate ACP conversations with individuals who are in their last few years of life. The Advanced Steps planning conversation is focused on assisting those with advanced serious illness and frailty in treatment decisions based on their goals of care. The Respecting Choices Advanced Steps ACP program’s systematic approach results in a POLST form or medical orders that aligns with individual goals, values, and preferences. These conversations have application for in-person visits and telehealth.
Target Audience
Advanced Steps ACP Facilitator Certification course is intended for healthcare professionals (nurses, social workers, chaplains, physicians, advanced practice providers) and other care providers.
Purpose
The purpose of this course is to assist participants in learning effective communication and conversation skills and techniques for facilitating person-centered conversations for those living with advanced medical conditions and frailty. These conversations have application for in-person visits and telehealth.
Course content level: Intermediate for social workers.
Learning Outcomes
At the end of this course, the participant will be able to:
- Identify communication skills for facilitating Advanced Steps ACP conversations.
- Demonstrate the application of the person-centered decision-making framework to elicit preferences and decisions.
- Create strategies to transfer individual goals, values, and preferences to a written plan, e.g., POLST form and out of hospital medical orders.
- Demonstrate beginning competency in facilitating Advanced Steps ACP conversations through role-play activities.
- Define benefits of (stage-specific) ACP conversations and identify appropriate target population.
- Demonstrate the application of the person-centered decision-making framework to elicit preferences and decisions.
- Create strategies to transfer individual goals, values, and preferences to a written plan, e.g., advance directive.
- Demonstrate beginning competency in facilitating Advanced Steps ACP conversations through role-play exercises.
Initial Certification Requirements
- Attend the ACP Core Component course.
- Completion of Respecting ChoicesAdvanced Steps ACP Facilitator Certification Online Curriculum (Modules 1-5)
- Completion of the Advanced Steps ACP Facilitator Certification classroom training (In-person classroom learning or Live distance learning webinar/virtual learning environment)
View Upcoming Respecting Choices National Courses
The Respecting Choices Facilitator Certification course may be provided:
- By Respecting Choices within an implementation agreement (First Steps, Next Steps, and Advanced Steps);
- By ACP Instructor/Faculty (First Steps, Next Steps, and Advanced Steps); or
- By attending a Respecting Choices National Course (First Steps, Next Steps, and Advanced Steps).
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