Developing a Spiritual Assessment Toolbox: A Discussion of the Strengths and Limitations of Five Different Assessment Methods

Article excerpt

It is increasingly recognized that health care professionals should consider conducting a spiritual assessment as part of holistic service provision (Plante & Sharma, 2001).Assessment helps to provide effective, culturally sensitive services while concurrently providing a forum to explore spiritual strengths that might he used to ameliorate problems or cope with difficulties. Spirituality is often a core animating principle in clients' view of reality; their spirituality, thus, often fosters a culturally distinct worldview. Hindus, evangelical Christians, traditional Catholics, Muslims, Mormons, Pentecostal Christians, and Orthodox Jews are all examples of populations who have developed distinct cultures. Clients' spiritual worldviews often guide their attitudes and behavior in a number of areas of significance to social workers, including their views on child care, communication norms, diet, family relations, gender interactions, marital relations, medical care, recreation, and schooling. Many Muslims, for example, are uncomfortable receiving medical services from providers of the opposite sex unless a member of the same sex--a family member, preferably--is present (Hodge, 2002). Spiritual assessment provides a window into these worldviews and enables social workers to tailor services in a manner that respects this most important aspect of clients' cultures.

In addition, a growing body of research indicates that spirituality is often a significant client strength (Johnson, 2002; Koenig, McCullough, & Larson, 2001). Spiritual assets, such as prayer, meditation, worship, scripture reading, clergy consultation, and spiritual groups, can facilitate coping, well-being, and recovery. A client wrestling with mental illness, for example, may find the support of a church group instrumental to his or her recovery upon discharge.

Assessment provides a method of identifying spiritual assets that can be operationalized in treatment and discharge planning. Consequently, social workers are being called on more often to conduct spiritual assessments. Perhaps most prominently, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the organization that accredits most hospitals and many other health care providers in the United States, now recommends that a spiritual assessment be conducted (JCAHO, 2001). At a minimum, JCAHO stipulates that a spiritual assessment should determine the client's denomination as well as important spiritual beliefs and practices. The purpose of the initial assessment is twofold. One goal is to identify the effect of client's spirituality on service provision and client care. As implied earlier, for service provision to be as effective as possible, spiritual beliefs and practices often have to be taken into account. Adherents of the Islamic faith, for example, may refrain from ingesting medicines containing alcohol or pork by-products (Hodge, 2004a). A Hindu person's recovery from schizophrenia might be aided by engaging in spiritual practices such as meditation and ritual offerings, such as puja, an act that shows reverence of a god, spirit, or other divine being (Hodge, 2004c).

Another goal is to identify whether an additional, more comprehensive spiritual assessment is required. JCAHO does not stipulate the conditions under which additional assessments are warranted so social workers must use their own judgment. Two general guidelines, however, may be useful in making such a determination. First, assessment is generally called for when the norms of the client's faith tradition relate to service provision and client care, as might occur with Pentecostalism and mental illness. Hearing the voice of God is considered normative within the Pentecostal tradition, for example, so hearing a voice external to oneself is not necessarily a manifestation of mental illness with Pentecostal Christians. In such cases, a comprehensive assessment is necessary to determine whether the voices are, in fact, a sign of mental illness or are normative, and quite possibly, a strength (Hodge, 2004b). …