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Spiritual Assessment
Defined
Spiritual assessment is the process by which health
care providers can identify a patient's spiritual needs
pertaining to their mental health care. The determination
of spiritual needs and resources, evaluation of the
impact of beliefs on healthcare outcomes and decisions,
and discovery of barriers to using spiritual resources
are all outcomes of a thorough spiritual assessment.
At St. Elizabeth's Hospital in Washington, D.C., the
Chaplain Program, headed by Clark Aist, conducts a "Spiritual
Needs Assessment" on each inpatient, concluding
with a treatment plan that identifies religious/ spiritual
needs and problems, role of pastoral intervention,
and religious/spiritual activities recommended.
When I started the year-long human sexuality training
program at the UCLA Neuropsychiatric Institute, we
were given the assignment to pair up and interview
each other about our sexual histories--our first sexual
memories, wet dreams, masturbation, petting, intercourse,
sexual problems etc. After all, if we were going to
ask our patients about their sexual experiences and
problems, we needed to be comfortable listening to
and talking openly about sexuality. Although we were
all licensed mental health professionals, we had not
been trained to talk with patients about their sexual
functioning or problems, and this exercise was a great
way to desensitize us (as in "systematic desensitization")
to the topic of sexuality.
I have found the same approach to be helpful with
the topic of spirituality, and have developed the following
interview as a desensitization exercise for training
mental health professionals to conduct assessments
of spirituality. I have used it at numerous workshops
and conference, and in my experience, most mental heath
professionals have an untapped reservoir of spiritual
depth that they have not had permission to bring it
into their clinical practices. I have also used this
assessment with patients in both the dual diagnosis
and chronic pain groups I have led at the San Francisco
VA.
The interview below was developed after consulting
many assessment instruments published in books and
articles, and disseminated at conference presentations.
It can usually be completed in 10 minutes.
Spiritual
Assessment Interview
A. RELIGIOUS BACKGROUND AND BELIEFS
1. What religion did your family practice when you
were growing up?
2. How religious were your parents?
3. Do you practice a religion currently?
4. Do you believe in God or a higher power?
5. What have been important experiences and thoughts
about God/Higher Power?
6. How would you describe God/Higher Power? personal
or impersonal? loving or stern?
B. SPIRITUAL MEANING AND VALUES
1. Do you follow any spiritual path or practice
(e.g., meditation, yoga, chanting)?
2. What significant spiritual experiences have you
had (e.g., mystical experience, near-death experience,
12-step spirituality, drug-induced, dreams)?
C. PRAYER EXPERIENCES
1. Do you pray? When? In what way(s)?
2. How has prayer worked in your life?
3. Have your prayers been answered?
 QUIZ
EXERCISES 14-24: Spiritual Assessment
Interview
Use the Spiritual Assessment Interview
with yourself.
Record your answers for later insertion
into the Quiz. |
FICA
Another approach to spiritual assessment uses the
acronym FICA.
F: FAITH AND BELIEFS
1) What are your spiritual or religious beliefs?
2) Do you consider yourself spiritual or religious?
3) What things do you believe in that give meaning
to your life?
I: IMPORTANCE AND INFLUENCE
1) Is it important in your life?
2) How does it affect how you view your problems?
3) How have your religion/spirituality influenced
your behavior and mood during this illness?
4) What role might your religion/spirituality play
in resolving your problems?
C: COMMUNITY
1) Are you part of a spiritual or religious community?
2) Is this supportive to you and how?
3) Is there a person or group of people you really
love or who are really important to you?
A: ADDRESS
1) How would you like me to address these issues
in your treatment?
QUIZ
EXERCISES 25-27: Spiritual Assessment
Interview
Use the FICA with yourself.
Record your answers for later insertion
into the Quiz. |
FICA is described in more detail at the Improving
Care for the End of Life: A Sourcebook for Health
Care Managers and Clinicians web site.
HOPE Assessment
Yet another approach to spiritual assessment is entitled
HOPE, where
 H--sources
of hope, strength, comfort, meaning, peace, love
and connection
O--the role
of organized religion for the patient
P--personal
spirituality and practices
E--effects
on medical care and end-of-life decisions
Questions used in this approach are on included in
this article:
Spirituality
and Medical Practice: Using the HOPE Questions as
a Practical Tool for Spiritual Assessment GOWRI
ANANDARAJAH, M.D., and ELLEN HIGHT, M.D., M.P.H American
Family Physician
EXERCISE: Take 10 minutes and answer the questions
for the FICA or the Religious and Spiritual History.
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