PSA6669 - SECTION 6: ASSESSMENT OF SPIRITUALITY/RELIGION
There are four reasons why practitioners need to incorporate a spiritual assessment into their comprehensive psychosocial assessment process. These four reasons relate to the practitioner’s cultural competence, identification of resources for strengths, individual autonomy and accrediting requirements. [Hodge DR (2005) Spiritual Assessment in Marital and Family Therapy: A methodological framework for selecting among six qualitative assessment tools. J Marital and Family Therapy, 26, 229-240]
As a group, social workers are at a disadvantage when it comes to incorporating spirituality or religion into a comprehensive psychosocial assessment. Practitioners may be uncomfortable with the idea of religion or they may lack knowledge or understanding of spiritual or religious beliefs.
Practitioners may also have a fear of being misperceived or misinterpreted by the individual being assessed, or and they may just lack the education and training to add a spiritual component to the assessment process. [Hodge DR (2005) Spiritual Ecograms: a new assessment instrument for identifying clients’ strengths in space and across time. Families in Society: Apr-Jun 2005, 86, 2, 287-296]
It is important for the practitioner to have an awareness and understanding of their own position with respect to spirituality and religion. Spirituality and religion may be overlapping concepts but they are distinct.
Spirituality is not necessarily theistic, but pertains to the meaning and purpose of life, the individual’s values, meaning and purpose. [Pierpont JH (2003) Spiritual assessment. Social Work Oct 2003]. Religion is the expression of the person’s spiritual relationship with particular beliefs, practices, rituals that have been developed within a community with others who share a similar understanding and belief system. [Pargament KI (1997) The psychology of religion and coping. New York: Guilford Press].
Practitioners need to be aware that it is possible for a person to have deep spiritual beliefs and values without belonging to a faith community. Usually, those individuals who belong to a faith community also express strong spiritual beliefs and values in addition to their specific religious practices.
Spiritual beliefs and religious practices are a strong influence on every aspect of life and are a source of strength and stability during times of crises. [Mahoney A, et.al., (2001) Religion in the home in the 1980s and 1990s: a meta-analytic review and conceptual analysis of links between religion, marriage and parenting. J Family Psychology, 15,559-596] Some clients may even define all other aspects of their psychosocial interactions - and what those interactions mean - around a central core of spiritual belief. For this reason, even clinicians who do not themselves ascribe to a religious or spiritual orientation must be willing to make a place for this component in their psychosocial assessment process.
The Joint Commission recommends an initial brief spiritual assessment to identify how the individual’s beliefs and practices influence their functioning, with a second goal of establishing the need for a more comprehensive assessment. [The Joint Commission, (2008) http://jointcommission.org ]
At minimum the brief spiritual assessment should include the individual’s denomination, beliefs, and what spiritual practices are important. A comprehensive spiritual assessment should be initiated if the norms of the faith tradition relate directly to the provision of client care or when spirituality plays a central role or functions as an organizing principle in the individual’s life.
Examples of norms of faith tradition that relate directly to the provision of client care include Jehovah Witness refusal of blood products, the Seventh Day Adventist’s refusal of meat products, the Pentecostal tradition of “hearing the voice of God” as normative in that community of faith - so that it does not necessarily indicate a manifestation of mental illness.
Examples of religious practices that play a central role or function as an organizing principle in the in the individual’s life might include Roman Catholics who attend daily Mass, Muslims who practice the Five Pillars of Islam or the practice of orthodox Judaism.
As with any comprehensive assessment process, the practitioner has both qualitative and quantitative methods of conducting the assessment. The qualitative methods include spiritual history or narrative, spiritual life maps, spiritual genograms, the spiritual ecomap and the spiritual ecogram.
Each method focuses on a different time frame or approach model. The practitioner needs to carefully select the method that is the most appropriate “fit” for the individual in order to maximize the accuracy and consistency of the information provided by the individual. The time period that is of therapeutic interest is most likely to be relevant and reliable.
If the method of assessment covers a period of time unrelated to the issues, the information may be compromised by errors related to unrelated or extraneous information. By focusing on the issue that has brought the individual to the assessment process, the practitioner can increase the individual’s perception that the assessment is appropriate and relevant to their situation. This will increase the individual’s engagement in the therapeutic process. [Foster SL & Mash EJ (1999) Assessing social validity in clinical treatment research: issues and procedures. J Consulting Clinical Psychology, 67, 308-319]
For those issues that lend themselves to intergenerational approaches - such as family of origin issues or interfaith conflicts, or with cultural groups who have an extended family view, such as persons of Hispanic background, persons who practice in the Muslim or Hindu faith - the choice of method might be the spiritual genogram or ecogram.
For those individuals whose issues are more present focused, the practitioner might want to consider the use of the spiritual ecomaps, spiritual life maps or spiritual history. Of these the spiritual life map is the most individual focused assessment tool. It is easily completed as an independent or family project and validates the individual’s competence and self efficacy.
There are also quantitative measures of spiritual assessments. These include the Spiritual Well Being Scale,a non-sectarian 20-item scale that measures two psychological dimensions of well being. One dimension is the individual’s relationship with God, the other is the individual’s relationship with others.
The Religious Orientation Scale is a 21-item scale designed to assess the degree to which the individual is motivated by spirituality. [Boivin MJ, Kirby AL, Underwood, LK & Silva H (1999) Spiritual Well being Scale (Paloutzian & Ellison, 1982; Ellison, 1983). In P.C. Hill & R.W. Hood, Jr. (Eds), Measures of Religiousity (pp382-385) Birmingham AL: Religious Education Press]
The six-item Religious Orientation Scale assesses spiritual motivation and is designed to work with both theistic and non-theistic populations. [Hodge DR (2003) The intrinsic spirituality scale: a new 6 item instrument for assessing the salience of spirituality as a motivational construct. J Social Research, 30, 41-61].
There are two additional quantitative measures that the practitioner could consider using: The Spirituality Scale and the Comprehensive Assessment of Spiritual Needs. [Delany C (2005) The spirituality scale: development and psychoetric testing of a holistic instrument to assess the human spiritual dimension. J of Holistic Nursing, 23, No 2, 145-167. Galek K, Flannelly KJ, Vane A and Galek RM (2005) Assessing a patient’s spiritual needs: a comprehensive instrument. Holistic Nursing Practice, 19, No 2, March April, 62-69. ]