Developing a Spiritual Assessment Toolbox Article Review Each Journal Article Summary must be 3–5 double-spaced pages (not including the title and referenc

Developing a Spiritual Assessment Toolbox Article Review Each Journal Article Summary must be 3–5 double-spaced pages (not including the title and reference pages) and created in a Microsoft Word document. Use the following guidelines to create your paper:Start your paper with a title page, correctly formatted per current APA. Use the provided template and the basic current APA components will be in place. Divide your paper into sections with the following Level One headings: Summary, Reflection, and Application as described on the template.Develop a summary (35 points) of the main concepts from the article. Do not duplicate the article’s abstract. If the article describes a research study, include brief statements about the hypotheses, methods, results, discussion, and implications. If any test measures or statistical methods used are given in the article, do not provide detailed descriptions of these. Short direct quotations from the article are acceptable, but avoid long quotes in a paper this size. This section is the foundation of your Journal Article Review (at least a third of your paper). Make sure you include the core points from the article, even if it means a longer section. Do not reference any additional articles in your summary.In approximately 1 page, reflect (10 points) on the article using your own words. Appropriate comments for this part of the paper could include, but are not limited to, your initial response to the article, comments regarding the study’s design or methodology (if any), insights you gained from reading the article, your reasons for being interested in this particular article, any other readings that you may plan to do based upon having read the article, and other thoughts you have that might further enhance the discussion of your article. Your subjective comments in this section must be clearly tied to main points from the article, not peripheral ideas. Again, do not reference any other article.In your final section, in approximately 1 page, write how you would apply (25 points) the information you have learned from this article to a particular counseling setting. Make this setting one that would typically be seen in human services counseling—community services agencies, adoption agencies, volunteer counseling settings such as in churches, etc. Develop this section as if you are a pastor or clinician and your parishioner or client has come to you with a problem—grief, depression, substance abuse, relationships problems, etc.— needing your help. Adequately describe the counseling scenario including the presenting problem. Draw out concepts from the article and apply them to the scenario as if you were guided only by the content of the article. Show the reader how you expressly drew from the journal article in this application section and cite correctly, per APA. Developing a Spiritual Assessment Toolbox:
A Discussion of the Strengths and Limitations
of Five Different Assessment Methods
David R. Hodge
Increasingly, social workers are being called on to conduct spiritual assessments, yet few
assessment methods have appeared in academic literature. This article reviews five
complementary assessment approaches that have recently been developed to highlight different
facets of clients’ spiritual lives. Specifically, one verbal model, spiritual histories, is discussed,
along with four diagrammatic approaches: spiritual lifemaps, spiritual genograms, spiritual
ecomaps, and spiritual ecograms. An overview of each approach is provided along with a
discussion of its relative strengths and limitations. The aim here is to familiarize readers with a
repertoire of spiritual assessment tools so that the most appropriate assessment method in a
given client-practitioner setting can be selected.
KEY WORDS: assessment; religion; spirituality; spiritual sensitivity; spiritual strengths
t is increasingly recognized that health care professionals should consider conducting a spiritual assessment as part of holistic service provision (Flante & Sharma, 2001).Assessment helps to
provide effective, culturally sensitive services while
concurrently providing a forum to explore spiritual strengths that might be 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 tbese worldviews and
enables social workers to tailor services in a manner that respects tbis most important aspect of clients’ cultures.
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In addition,a growing body of research indicates
that spirituality is often a significant client strength
(Jobnson, 2002; Koenig, McCuUougb, & Larson,
2001). Spiritual assets, such as prayer, meditation,
wonhip, 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 churcb group
instrumental to his or ber recovery upon discharge.
Assessment provides a method of identifying
spiritual assets tbat 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 QCAHO), tbe organization that accredits most hospitals and many otber health care
providers in the United States, now recommends
that a spiritual assessment be conducted (fCAHO,
2001). At a minimum,JCAHO stipulates that a spiritual assessment should determine tbe clients denomination as well as important spiritual beiiefi
and practices.Tbe purpose of the initial assessment
is twofold. One goal is to identify tbe 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
bave to be taken into account. Adherents of the
CCC Code: 0360-7283/05 13.00 e200S National Auoclation of Social Worker}
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, sucb 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 tbe client’s faitb
tradition relate to service provision and client care,
as might occur witb Pentecostalism and mental illness. Hearing tbe voice of God is considered normative w ithin 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 tbe
voices are, in fact, a sign of mental illness or are
normative, and quite possibly, a strength (Hodge,
2004b).
Next, a comprehensive assessment should be
considered when spirituality plays a central role,
fiinctioningas an organizing principle,in the client’s
life,The extent to which clients practice tbe tenets
of their faith tradition is one way to assess the centrality of spirituality in tbeir lives. For example, a
comprehensive assessment may be warranted with
Catholics who attend mass weekly or Muslims who
practice the five pillars.
Although social workers are called on increasingly to conduct spiritual assessments, relatively
few assessment methods have been developed
(Sherwood, 1998). Furthermore, studies indicate
tbat most social workers bave received little, if any,
exposure to spiritual assessment during their graduate education (Canda & Furnian, 1999; Murdock,
2004). Accordingly, this article introduces readers
to a complementary set of assessment methods and
reviews the strengths and limitations of each assessment approach. Botb clients and social workers bave a variety of needs and interests in any clinical context; consequently, some assessment
approaches will work better in some situations.The
family of assessment tools reviewed in this article
was deliberately designed to highlight different fac-
H O D G E / Developing a Spiritual Assessment Tooii)ox
ets of clients’ spiritual lives. Discussion of the
strengths and hmitations of each assessment method
is offered to belp social workers select the method
that best fits the needs of a given situation. In effect, this article provides social workers with an assessment “toolbox” from which practitioners can
select the most appropriate instrument.
The five assessment methods reviewed and compared are (1) spiritual histories (Hodge. 2001a),
which is the only verbally based approach discussed,
along with four pictorial approaches: (2) spiritual
lifemaps (Hodge, 2005b), (3) spiritual genograms
(Hodge,2001b),(4) spiritual ecomaps (Hodge,2000;
Hodge &Williams,2002).and (5) spiritual ecograms
(Hodge, 2005a).These methods are ail designed to
provide comprehensive spiritual assessments. Readen interested in an initial assessment model may
consult Hodge (2004b) for a short, oral tool designed to meet the JCAHO standards for conducting an initial spiritual assessment.Alternatively.it is
also possible to adapt these methods, particularly
spiritual ecomaps. to conduct an initial spiritual
assessment.
It is important to note at the outset that some
topics cannot be discussed due to space limitations.
Communications styles and many other facets of
behavior can be influenced by one’s spiritual and
cultural background, for example. Obtaining some
degree of knowledge regarding a client’s spiritual
tradition before assessment is generally helpful. It
is. however, beyond the scope of this article to
present information on various spiritual traditions,
guidelines for conducting an assessment in a spiritually competent manner, suggestions on appropriate spiritual interventions, or even detailed accounts of each assessment approach. Interested
readers are encouraged to obtain the original articles for information on these topics or consult
the works of other authors who address these subjects (Canda & Furman, 1999; Koenig, 1998a;
Richards & Bergin, 2000; Van Hook, Hugen, &
Aguilar,200I).
In addition, it is appropriate to specify the working definition of spirituality and religion. Altbough various definitions of these two constructs
have appeared in the literature, spirituality can be
understood as individual’s existential relationship
with God (or perceived transcendence), and religion can been seen as flowing from spirituality, the
actual expression ofthe spiritual relationship in particular beliefs, forms, and practices that have been
developed in community with other individuals
who share similar experiences of transcendence
(Hodge, 2001a).Thus, spirituality and religion are
overlapping but distinct constructs (Canda &
Furman. 1999).
SPIRITUAL HISTORIES
Oral spiritual histories are perhaps the most common approach to assessment (Hodge, 2001a).This
method is analogous to conducting a family history. In the spiritual history approach developed by
Hodge, two question sets are used to guide the
conversation. Tbe purpose ofthe first question set,
referred to as the Initial Narrative Framework, is to
provide practitioners with some tools to help clients tell their stories, typically moving fiom childhood to the present.
The second question set, referred to as the Interpretive Anthropological Framework, is designed to
elicit spiritual information as clients relate their stories.The framework is based on Nee’s (1968) anthropological understanding. In addition to soma
(that is, the physical human body). Nee envisioned
a soul, comprised of affect, will, and cognition, and
a spirit, comprised of communion, conscience, and
intuition. Although human beings are an integrated
entity, consisting of body, soul, and spirit, it is possible to distinguish the six dimensions of the soul
and spirit. Communion refers to spiritually based
relationship. More specifically, it denotes the ability
to bond and relate to God or tbe client’s perception
of transcendence. Conscience relates to one’s ability to seme right and wrong. Beyond a person’s
cognitively held values, conscience conveys moral
knowledge about the appropriateness of a given set
of choices. Intuition refers to the ability to know—
to come up with insights that bypass normal cognitive channels.
The anthropologically derived questions are designed to elicit information about each of tbe six
dimensions,providing a holistic spiritual assessment.
As clients relate their spiritual narrative (prompted
as necessary by questions drawn from the initial
narrative framework), they will tend to touch on
some of the dimensions listed in the interpretive
anthropological framework. Social workers can interject questions drawn from the anthropological
framework into the dialogue to more fully explore
clients’ spiritual reality in the natural flow of tbe
conversation. In short, the narrative questions help
chents tell their stories and the interpretive anthro-
pological questions assist practitioners in eliciting
important information as the stories unfold.
Strengths and Limitations of
Spiritual Histories
For verbally oriented people, spiritual histories may
provide the best assessment method. In addition,
the relatively unstructured format allows clients to
relate their stories in a straightforward manner
without having to adapt their narratives to fit a
particular diagrammatic format. For example,
whereas spiritual genograms require clients to circumscribe their spiritual stories to fit the parameters of a generational chart, spiritual histories allow clients to express themselves in a manner that
is unique to their own experience. Spiritual histories are also easy to conduct.The assessment model
is relatively easy to communicate to clients, and
the verbal format is conducive to building a therapeutic alliance with clients.
Not all clients are verbally oriented, however.
Some may prefer the pictorial assessment approaches
discussed in later sections. Individuals who are nervous about sharing what is often a highly personal
topic may desire a diagrammatic approach that deflects attention away from themselves and onto an
inanimate object. Some clients prefer having a specific framework around which to organize their
thoughts, such as a spiritual ecomap. Similarly, tbe
process of conceptualizing and depicting one’s spiritual journey pictorially may help to focus and objectify spiritual assets, which can then be discussed
and marshaled to address problems. Another limitation is the time spent exploring portions of the
client’s spiritual history tbat may have limited utility in addressing the present problem with which
the client is wrestling. In addition, more artistic
clients may desire an assessment approach, sucb as
spiritual lifemaps. that allows for a more creative
expression of their spirituality.
SPIRITUAL LIFEMAPS
Spiritual lifemaps represent a diagrammatic alternative to spoken spiritual histories (Hodge, 2005b).
More specifically, spiritual lifemaps are a pictorial
delineation of a client’s spiritual journey. In a manner analogous to Augustine’s {354-430AD/1991)
Confessions, spiritual hfemaps are an illustrated account of clients’ relationship with God (or transcendence) over time—a map of their spiritual life.
Much hke road maps, spiritual lifemaps tell us where
Health & Social Work VOLUME 30, NUMBER 4
NOVEMBER 2005
we have come fiom, where we are now, and wbere
we are going.
At its most basic level, a drawing pencil is used to
sketch various spiritually significant life events on
paper,The method is similar to various approaches
drawn fiom art and family therapy in which a client’s
history is depicted on a “lifeline” (Tracz & GehartBrooks. 1999).To assist clients in the creative expression of their spiritual journeys, it is usually best
to use a large sheet of paper (for example, 24″ x
36″) on which to sketch the map. Providing drawing instruments of different sizes and colors is also
helpful, as is offering a selection of various types
and colors of construction paper and popular periodicals. Providing these items, in conjunction with
scissors, gjue, and rulers, allows clients to clip and
paste items onto the lifemap.
Spiritually significant events are depicted on a
path, roadway,or a single line that represents clients’
spiritual sojourn (Figure l).Typically, the path proceeds chronologically, from birth to the present.
Frequently, the path continues on to death and the
client’s transition to the afterlife. Hand-drawn symbols, cut out pictures.and other material are used to
mark key events along tbe journey. In keeping with
many spiritual traditions, which conceive material
existence to be an extension ofthe sacred reality, it
is common to depict important secular events on
the lifemap (for example, graduation, loss of a job.
or a car accident), Evangelicals, for example, will not
see marriage or death as secular. Although it is often
necessary to provide clients with general guidelines,
client creativity should be encouraged.
To fully operationalize tbe potential of tbe
method, it is important to ask clients to incorporate the various trials they have faced along with
the spiritual resources they have used to overcome
those trials. Hills, bumps, potholes, rain, clouds, and
lightning, can be used to portray difficult life situations. Delineating successful strategies that clients
have used in the past frequently suggests options
for overcoming present struggles.
Strengths and Limitations of
Spiritual Lifemaps
Ofthe assessment methods reviewed in this article,
spiritual lifemaps are perhaps the most client directed. The relatively secondary role that social
workers play during this type of assessment offers
important advantages. Less risk exists that social
workers may jeopardize the therapeutic relation-
H O D G E / Developing a Spiritual Assessment Toolbox
The pictorial lifemap affhrds practitioners
the opportunity to learn more about the
client’s worldview, while focusing on
building therapeutic rapport.
ship through comments that are inadvertently offensive—an important consideration given that most
social workers have had minimal, if any, training in
spiritual sensitivity (Canda & Furman, 1999).The
pictorial lifemap affords practitioners the opportunity to learn more about the client’s worldview,
wbile focusing on building therapeutic rapport by
providing an atmosphere that is accepting,
nonjudgmental. and supportive during assessment.
By placing a client-constructed media at the center
of assessment, the message is implicitly communicated that the client is a competent, proactive, selfdirected, and fully engaged participant in the therapeutic process. For clients for whom spirituality is
a highly sensitive and significant area, lifemaps provide a means of shifting the focus from the client to
a more neutral object, a process that may help set
clients at ease. In addition, individuals who are not
verbally oriented may find pictorial expression more
conducive to their personal communication styles,
and more creative individuals may feel that this assessment approach allows them to express their
spiritual journey in a manner that is more personally authentic. Lifemaps fit well with interventions
drawn from existential therapy that emphasizes the
brevity of life, and they may be assigned as “homework,” saving valuable therapeutic time.
Some social workers, however, may feel so removed from the process that this assessment approach makes poor use of therapeutic time. Another significant hmitation is that many clients.such
as those who are more verbal, uncomfortable with
drawing, or prefer more direct practitioner—client
interaction, may find the use of a largely nonverbal,
pictorial method to be a poor fit with their current
needs. In other situations, it may be important to
understand the effects of spirituality in greater
breadth (that is, among the wider family system) or
in greater depth (that is, across generations). In such
settings, spiritual genograms may be used.
SPIRITUAL GENOGRAMS
Spiritual genograms provide social workers with a
tangible graphic representation of spirituality across
at least three generations (Hodge. 2001 b) .Through
the use of what is essentially a modified family tree,
they help both practitioners and clients understand
the flow of historically rooted patterns through time.
In short, spiritual genograms are a blueprint of compiex intergenerational spiritual interactions.
The basic family system is delineated in keeping
with standard genogram conventions (McGoldrick,
Gerson, & Shellenberger, 1999).Triangles or other
geometric shapes, however, can be inserted to designate individuals who have played major spiritual
roles but are not members of tbe immediate biological family (for example, see “Ruth” in Figure
2). To indicate clients’ spiritual tradition, colored
drawing pencils can be used to shade in the circles
and squares. Color coding provides a graphic “color
snapshot” of the overall spiritual composition of
the family system. Various colors can be used to
signify religious preference (for example. Muslim,
New Age, none), or when the information in
known, denomination (for example. Assemblies of
God) and subtradition (for example. Sunni,Sbiite).
A circle representing a member ofthe Assemblies
of God could be colored red and an individual
whose affiliation and beliefs are unknown could be
left uncolored. A change in an adult’s religious orientation can be signified by listing the date ofthe
change beside a circle, which is drawn outside the
figure, and filling in the space between the circle
and the figure…
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