Using Spiritual Assessment to Facilitate Spiritual Care

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Using Spiritual Assessmentto Facilitate
Spiritual Care
Caring for the Spiritual Lives of Seniors
Presenter Rev. James W. Ellor, Ph.D., D. Min.,
LCSW, ACSW, BCD, DCSW, CGP, CSW-G Professor
School of Social Work, Baylor University Editor
Journal Of Religion, Spirituality and
Aging Parish Associate First Presbyterian Church
of Waco
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Planning Teams -1 (10 minutes)

• Find a group of 4-6 persons that you can work
  with as a team throughout the day. Consider
  finding people that you do not know ahead of
  time.
• Discuss together what your goals are for today.
  What do you want to get from today?
• You have 10 minutes for this exercise

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Discuss with the group the tools you hope to
assess

• Religion
• Spirituality
• Faith
• Faith Development
• Faith Development
• Spiritual Coping
• What else?

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Theoretical Issues
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Why do assessment?

• Offers voice to spiritual needs
• Enhances inter-disciplinary cooperation
• Mandated by Joint Commission for Long Term Care
  and Hospice

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Joint Commission

• Minimum Standards
• Determine the patients denomination
• Beliefs
• What Spiritual Practices are important
• Hope, Despair, views of death
• Is the patients spiritual practice helpful in
  coping with suffering and life in general?
• All Joint Commission Standards are intended to be
  integrated with other logical standards, such as
  Behavioral Health

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Where to find Joint Commission Standards

• The Joint Commission directly requires Spiritual
  Assessment in
• Long Term Care
• Hospice
• The Hospice Standards offer a fuller reflection
  of the thinking of the commission

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Spiritual Assessment
Definitions are the first step then

• Definition
• Assessment
• Treatment
• outcome ?

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Constructing a new wholistic paradigm
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The Person
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A Matter of Perspective

• Theology
• Theo centric
• Anthro centric
• Psychology
• Paradigms
• Philosophies
• And More

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Anthro centric

• Starts from understanding that humanity can not
  fully understand God
• Therefore it is understood that humanity can only
  view God through human eyes. In other words,
  humanity looks up at God
• Key is role of revelation

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An Anthrocentric perspective
Thibault, Jane M., James W. Ellor, and F. Ellen
Netting. "A Conceptual Framework for Assessing
the Spiritual Functioning and Fulfillment of
Older Adults in Long-Term Settings." Journal of
Religion and Aging 7, no. 4 (1991) 29-46.
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Fowlers Stages

• Pre-stage Infancy Undifferentiated Faith Stage
• Stage 1 Intuitive-Projective Faith
• Stage 2 Mythic-Literal Faith
• Stage 3 Synthetic-Conventional
• Faith
• Stage 4 Individuative-Reflective
• Faith
• Stage 5Conjunctive Faith
• Stage 6 Universalizing Faith
• James W. Fowler, 1995, Stages of Faith, San
  Francisco Harper and Row.

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Coping ModelBased on the work of Ken Pargament
Interrelations of Stress Buffers

• Social Support
• Coping Skills
• Perception of stressor and coping ability
• Sources of Meaning
• Biological resilience
• Hartz, G. W. (2005). Spirituality and mental
  health Clinical applications. Binghamton The
  Haworth Press.

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Hierarchy of Sources of Meaning
Marginal Sources of Meaning
Secondary Sources of Meaning
Foundational Sources of Meaning
Hartz, G. W. (2005). Spirituality and mental
health Clinical applications. Binghamton The
Haworth Press.
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Religious Coping Methods

• Spiritual Support and collaborative Coping
• Belief that one is receiving support and guidance
  from God God is seen as another member of the
  support network.
• Congregational Support
• Helpfulness of clergy, lay leaders, and fellow
  congregants in times of stress
• Benevolent religious reframing
• Attributing the stressful event to the will of
  God or to a loving God

Hartz, G. W. (2005). Spirituality and mental
health Clinical applications. Binghamton The
Haworth Press.
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Four Reliable Aspects of Religion and Spirituality

• Prayer helps
• People use their beliefs in coping, particularly
  with tragedy
• Religion seems to influence
• Immune
• Endocrine
• Nervous systems
• Ritual as comfort in times of pain or anxiety
• Community Support come from Faith Based
  Community Services
• Provides values and answers basic life questions

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Outcome Examples (So what!)

• If you learn that the senior employs religion as
  a coping mechanism, how will that impact working
  with the person when she/he is anxious?
• If you learn that she/he is Presbyterian, how
  will that impact services, such as referral to
  chaplaincy or the selection of a pastor to come
  talk with the senior?
• If you learn that the person is oriented toward
  mysticism, how will that impact the way you
  understand their discussions of future events or
  anxieties?

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Coping Defined

• Coping refers to efforts to master conditions of
  harm, threat, or challenge when a routine or
  automatic response is not readily available.
• Monat, A. and R. S. Lazarus (1977). Stress and
  Coping An Anthology. New York, Columbia
  University Press.

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Coping Mechanisms

• DenialKeeping negative events from conscious
  awareness
• Sublimation Aggressive impulses are diverted
  into prosocial behaviors
• Projection
• Attributing to someone else ones own thoughts
  or feelings.
• Displacement Deflecting feelings from their
  original target to someone else
• Reaction formation
• Unacceptable wishes or impulses are transformed
  into their opposite

• Intellectualism/rationalization
• Symptom Conversion
• Planning
• Restraint
• Reframing
• Use of social support
• Acceptance
• Use of humor

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Coping

• Most common mechanism involving religion is
  reframing
• 3 natural Mechanisms
• A system of beliefs Mental attitudes
• Increased social support
• Focus on others (transcendence)

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Mechanisms for Optimism Hope

• Positive Hymns
• Positive Theologies pervasive within congregation
• Prayer in times of trouble (We are never alone)
• The concept of a loving, forgiving Devine partner
  in life

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Social Support

• Congregational Care giving
• Congregational support for families
• Congregational Information and Referral
• Clergy most likely turned to in times of crisis

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Assessment Keys

• The nature of God
• Is God approachableif so how?
• The on going role of, or presence of God in the
  life of the client/patient
• The role of humanity in the on-going creation of
  our environment
• The role of rituals
• The place of mystical events and understandings
  of divine intervention
• The nature of and need for critical elements of
  participation in the faith community, such as
  worship, prayer, anointing, etc.

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Team Meeting 3 (20 minutes)

• This is a time to brain storm with your team.
• What types of topics do you need to cover in your
  assessment?
• How will this fit into the other types of
  assessments being done, either by you, or by
  colleagues?
• What outcomes do you expect from this assessment?
  (This may be a good question to start your
  discussion with!)
• Be prepared for a brief popcorn feedback session
  with the entire group by offering some ideas back
  to the group

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Assessment Technology

• The nuts and bolts of getting it done

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Steps in Assessment

• Determine what is to be assessed. Definition is
  critical
• Determine the how, and by whom, the data will be
  used
• Determine who will do the evaluation
• Develop an approach
• Implement and constantly reevaluate process
• Risk Factors

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Possible Formats

• Open ended Questions
• Structured Questions
• Targeted content with clear categories of
  response
• Still open
• Closed questions
• Full Psychometric design
• Eco-mapping

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Eco Map for Spiritual Assessment
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Topics for Inclusion

• Now that you have the big picture, what are the
  specific items that you want to put into your
  assessment tool?

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Common Elements in Spiritual Assessment

• Doug Olson, building on the work of the Fetzer
  Foundation in his study of common variables used
  in spiritual assessment found the following eight
  variables to be commonly found in all of the
  religious and spiritual research instruments
  gathered for their research These variables are
• Olson, Doug, In press, Religiosity and
  Spirituality Assessment Approaches and Tools, in
  Robert and Rosalie Kane Assessing Older Persons.
  Oxford University Press.
• Fetzer Working Group (1998). Brief Measure of
  Religiousness and Spirituality, Jointly sponsored
  by NIA and Fetzer. Kalamazoo, Michigan.

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Variables

• Dependent
• Relationship
• Religious History
• Organizational Practice
• Degree of Commitment

• Independent
• Private Daily Experience
• Value Systems and Ethical Precepts
• Spiritual and Religious Beliefs
• Spiritual Development

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Fetzer Institute 12 Domains

• Daily Spiritual Experience
• Religious/Spiritual coping
• Private religious practices
• Religious/spiritual history
• Organizational religiousness
• Religious preferences

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Fetzer Institute 12 Domains, continued

• 7. Meaning
• 8. Commitment
• 9. Forgiveness
• 10. Values
• 11. Beliefs
• 12. Religious Support

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Possible Elements

• Spiritual History
• Denominational history
• Oral History
• Coping
• Meaning
• Pathology Assessment
• Activities
• View of death and Afterlife
• Important or Meaningful Symbols
• View of God
• Role of Prayer
• Motivation for health or Wellness
• Spiritual reminiscence
• Eco mapping

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Constraints

• Time/Staff
• Need
• Cognition on the part of the senior
• Assess to family or other key informants
• History

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Confidentiality

• New Laws on confidentiality
• Need Client/patient permission
• Work out with supervisor and administration

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How and by whom will data be used?

• Chaplains office
• Clinical Assessment
• Interdisciplinary Team
• Statistical Reporting
• Community Liaison
• Nursing Assessment

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Determining who will do the assessment

• Chaplain
• Volunteer
• Social Service
• Nursing
• Activities

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Team Meeting- 4 (15 minutes)

• Who will do it?
• What format will you use?
• Paper and pencil
• Interview
• Small group
• What do you want to get out of it?
• How will it interface with other assessments
• How will it be used?
• What Elements do you want in your assessment tool?

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Intervention Examples

• Different interventions require different
  assessment strategies

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Role related construction for example Parish
Nurse or Chaplain Interventions

• Spiritual Mapping
• Spiritual Crisis Intervention
• Counseling
• Grief Support

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Task Oriented AssessmentSpiritual Crisis
Intervention

• Religion as coping mechanism
• Spiritual community support
• Ritual as comfort in times of pain

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Task Oriented AssessmentCounseling

• Wholistic assessment to include the spiritual
• Spiritual Crisis Intervention
• Spiritual wellness or strengths
• Religious community support

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Task Oriented AssessmentGrief Support

• Comfort in times of loss
• Religion as coping
• Community support

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Task Oriented AssessmentCommunity Liaison

• Assessment of residents in order to build bridges
  with community congregations
• Knowledge data base for programming
• Data base to bridge with needed faith communities.

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Team Meeting 5
(30Minutes)Putting it all together

• Work with your team to develop your own
  assessment tool

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Building your own assessment - Goal

• What is your goal
• Basic assessment for brief intervention
• May not want a paper and pencil tool, rather a
  short memorizable instrument
• Short portable tool
• Written tool that can be placed into a chart
• Depth assessment to bridge with interdisciplinary
  team

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Developing the tool

• Demographic Questions
• Assessment of the spiritual
• Assessment of the need for or types of
  intervention
• Assessment interface with psychology

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Finalize approach

• Finalize tool
• Field test tool
• Employ tool
• Reevaluate tool

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Where to go from here

• Design a Spiritual Strategy
• Discovery Assessment
• Insight Team meeting
• Action Intervention

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Final Team Meeting - 6

• Put it all together
• Who?
• Will do what?
• To whom?
• For what purpose?
• How will it be evaluated?