Spiritual Assessment In Clinical Practice: What to Do and When to Refer

1. Spiritual Assessment In Clinical Practice:What to Do and When to Refer Cantor Rabbi Rob Jury, MA Candidate Rev. Dr. Nate Perron, M.Div, PhD, LCPC, NCC, ACS, CERC Director of Clinical Training, Core Faculty at

2. Overview

3. ACA Code of Ethics:E.8. Multicultural Issues/Diversity in Assessment Assessments must be culturally appropriate based on a variety of cultural identities. “Counselors select and use with caution assessment techniques normed on populations other than that of the client. Counselors recognize the effects of age, color, culture, disability, ethnic group, gender, race, language preference, religion, spirituality, sexual orientation, and socioeconomic status on test administration and interpretation, and they place test results in proper perspective with other relevant factors (American Counseling Association, 2014).”

4. ASERVIC Spiritual Competencies10. Assessment Counselors make every effort to understand client spiritual perspectives “During the intake and assessment processes, the professional counselor strives to understand a client’s spiritual and/or religious perspective by gathering information from the client and/or other sources (Association for the Spiritual, Ethical, and Religious Values in Counseling, 2009).”

5. Spiritual Assessment as Multi-Cultural Competency Multi-cultural competency = Acknowledging spiritual/religious identities Professional counselors embrace multi-cultural competencies that include awareness and acknowledgement of religion and spirituality in the life of the client. With religion and spirituality no longer seen as simply a symptom of a pathology, counselors need to be equipped with evidence-based tools for spiritual assessment.

6. Spiritual Assessment as Multi-Cultural Competency Acknowledging spiritual/religious identities = Utilizing spiritual assessments accurately The multi-culturally competent counselor uses screening for spiritual struggle and taking a spiritual history as two methods of addressing and acknowledging a client’s religion and/or spirituality.

7. Spiritual Assessment as Multi-Cultural Competency The spiritual screen and spiritual history can also serve as tools to:

8. Goals of the presentation The goal of this presentation is to familiarize professional counselors with the three categories of spiritual assessment:

9. What is a Spiritual Assessment? Spiritual assessment = a broad and general term to describe any number of methods, interventions, and tools aimed at addressing spirituality in a clinical setting. “A spiritual screen, a spiritual history and a spiritual assessment are distinct in form and function.” (LaRocca-Pitts, 2012, p.26)

10. Every Counselor Can and Should • Screen for Spiritual Risk • Take a Spiritual History • Refer for In-depth Spiritual Assessment

11. #1 Screen for Spiritual Struggle/Risk Spiritual risk is : “being at risk for poor health outcomes as a result of underdeveloped, conflicted, overwhelmed, or negative spirituality. Focusing on a person’s spiritual resources and spiritual needs provides another way to think about spiritual risk. Spiritual risk is having high spiritual needs and low spiritual resources with which to address those needs (Fitchett & Risk, 2009, p.4).”

12. Examples of Tools to Screen for Spiritual Risk • Berg’s Spiritual Injury Scale (Berg, 1992) • Brief R-COPE (Pargament, 1998) • Spiritual Values Inventory (Stancil, 1999) • Rush Screener (Risk & Fitchett, 2009)

13. Spiritual Injury Scale (Berg, 1992)

14. Negative Religious Coping: Brief RCOPE (Pargament, et al, 1998)

15. Rush Screener (Risk & Fitchett, 2009)

16. Spiritual Screening and Intervention Rush Screener (Risk & Fitchett, 2009, p.9)

17. #2 Take a Spiritual History “The purpose of the spiritual history is to learn about how patients cope with their illnesses, the kinds of support systems available to them in the community, and any strongly held beliefs that might influence medical care. If the patient denies that religious or spiritual matters are important to him/her, then there is probably no need for further questions…(Koenig, 2004, p.2881).”

18. Spiritual History “…On the other hand, it is important to know whether the patient has any spiritual beliefs that might influence decisions about medical care. Some patient are members of a spiritual community, which may or may not be supportive. Patients may have specific spiritual needs that caregivers ought to address…(Koenig, 2004, p.2881).”

19. Spiritual History Guidelines and Recommendations Mark LaRocca-Pitts, PhD, BCC offers the following guidelines and recommendations when taking a spiritual history (LaRocca-Pitts, 2012, p.28): • Respect the client’s faith and beliefs and do not impose counselor’s beliefs on client. • The focus is less on what the client believes, rather it is on how the belief functions for the client. • The spiritual history does not try to “fix” anything the client believes. • Showing interest in a client’s spirituality and respecting the clients beliefs or lack of beliefs is a therapeutic intervention.

20. Examples of Spiritual History Tools • SPIRIT (Maugans, Ambuel, & Weissman, 1997) • CSI-MEMO (Koenig, 2004) • FICA (Puchalski and Romer, 2000) • HOPE (Anadarajah and Hight, 2001) • FAITH (King, 2002)

21. Spiritual History: CSI-MEMO (Koenig, 2004)

22. Spiritual History: FICA (Puchalski and Romer, 2000) F Faith, Belief, Meaning: “Do you consider yourself spiritual or religious?” or “Do you have spiritual beliefs that help you cope with stress?” I Importance or Influence of religious and spiritual beliefs and practices: “What importance does your faith or belief have in our life? Have your beliefs influenced how you take care of yourself in this illness? What role do your beliefs play in regaining your health? C Community connections: “Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you?” A Address/Action in the context of medical care: “How would you like me, your health care provider, to address these issues in your health care.”

23. #3 Refer for In-depth Spiritual AssessmentSpiritual Resources for Counselors • General spiritual resources, e.g., clergy, congregation, and or faith/wisdom community • Professional Chaplains

24. What is a Professional Chaplain? A professional chaplain typically holds: • A minimum degree of a Masters of Divinity or its equivalent (minimum of 72 graduate credit hours in divinity or related theological studies). • A minimum of 4 units of Clinical Pastoral Education (CPE) reflecting a minimum of 1600 hours of training in clinical spiritual care and assessment. • A Board Certified Chaplain (BCC) holds the above plus 2000 additional hours of work providing spiritual care and assessment in a clinical setting and has passed the written and oral requirements to receive certification. • Professional and Board Certified Chaplains may or may not be ordained, depending on their faith tradition.

25. Practice Taking a Spiritual Screen and Spiritual History In pairs or groups of three, we will spend approximately 10 minutes practicing screening for spiritual struggle and taking a spiritual history. Feel free to use the Rush Screener and/or the Brief RCOPE as spiritual screening tools and FICA to take a spiritual history.

26. Reflecting on the Experience • What feelings and thoughts came to mind when using the tools to screen for spiritual struggle and take a spiritual history? • In what ways were/weren’t your spiritual/religious beliefs reflected in the tools? • How do you perceive this may/may not be helpful? •  What else would you want to know when striving to offer support?

27. References • American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author. • Anandarajah, G. & Hight, E. (2001). Spirituality and Medical Practice: Using HOPE questions as a Practical Tool for Spiritual Assessment. American Family Practice 63, 81-88. • Berg, G. (1994). The Use of the Computer as a Tool for Assessment and Research in Pastoral Care. Journal of Health Care Chaplaincy 6 (1), 11-25. • Fitchett, G. & Risk, J. (2009). Screening for Spiritual Struggle. Journal of Pastoral Care and Counseling,63(4), 1-12. • Hodge, D. R. & Holtrop, C. R. (2002). Spiritual assessment: A review of complementary assessment models. In B. Hugen & T. L. Scales (Eds.), Social work and Christianity: Readings on the integration of Christian faith and social work practice (2nd ed., pp. 167-192). Botsford, CT: NACSW Press. • King, D.E. (2002). Spirituality and Medicine. In Mengel, M.B., Holleman, W.L., & Fields, S.A. (Eds.), Fundamentals of Clinical Practice: A Text Book on the Patient, Doctor and Society (651-659). NY, NY: Plenum. • Koenig, H. (2004). Taking a Spiritual History. JAMA, 29(1), 2881. • LaRocca-Pitts, M. (2012). FACT, A Chaplain’s Tool for Assessing Spiritual Needs in an Acute Care Setting. Chaplaincy Today,28(1), 25-32. • Maugans, T.A. (1997). The SPIRITual History. Archives of Family Medicine 5, 11-16. • Pargament, K. (1997). The Psychology of Religion and Coping: Theory, Research, Practice. NY, NY: The Guilford Press. • Puchalski, C.M. & Romer A.L. (2000)Taking a Spiritual History Allows Clinicians to Understand Patients More Fully. Journal of Palliative Medicine 3, 129-137. • Stancil, D. (1991). Spiritual Values Inventory. Retrieved from http://www.dcstancil.com/yahoo_site_admin/assets/docs/SVI_Development.137195455.pdf