Rationale behind a BPSS, sample questions, BPSS templates, assessing people without English
This page has three sections:
Background Material that provides the context for the topic
A suggested Practice Approach
A list of Supporting Material / References
Feedback welcome!
Background Material
BPSS Assessment is designed to give the social worker sufficient background to formulate a plan for the person, going-forward. Undertaking a BPSS assessment prior to looking at treatment options can be very useful in uncovering aspects of the service user’s life that may have remained hidden if problem solving commenced without the BPSS.
A BPSS assessment examines the biological, psychological, social and spiritual factors that impact on a person’s life. The following outline from the University of Nevada provides some idea of what information can be gathered, and the types of questions that can be used. Depending on the area of practice, social workers may choose to emphasise one or more of the four areas of the assessment and will, over time, develop their own approach to the BPSS.
[University of Nevada, Reno. School of Medicine. (n.d.). Bio-Psycho Social-Spiritual Model. Retrieved September 21, 2020, from https://med.unr.edu/psychiatry/education/resources/bio-psycho-social-spiritual-model]
[For additional information on cultural issues: Gale, L. (2022). Biopsychosocial-spiritual assessment: An overview.Cinahl Information Systems.https://www.ebsco.com/sites/default/files/acquiadam-assets/Social-Work-Reference-Center-Skill-Biopsychosocial-Spiritual-Assessment.pdf
Biological
Past
Genetics:
Consider whether any blood relatives that have had psychiatric problems, substance use problems or suicide attempts/suicides.
History of Pregnancy and Birth:
Consider pregnancy variables: Was there in-utero exposure to nicotine, alcohol, medications or substances? Anything unusual about pregnancy?
Note birth complications, such as prematurity, birth trauma or extended periods of hospitalization.
Relevant Previous Illnesses
Present
Current Illnesses:
Identify current illnesses and any direct impact they may have.
Medications:
Assess current medication regimen. Consider possible side effects of current medications.
Substances:
Consider the influence of nicotine, alcohol and street drugs on current psychiatric symptoms.
Consider the possible effects of substance withdrawal.
Psychological
Past
Comment on any past history of trauma, as well as resiliency.
Consider the sources of positive self-image and positive role models.
Comment on the patient's experience with loss.
Comment on the patient's quality of relationships with important figures, such as grand parents, friends, significant teachers, or significant employers.
Present
Describe the recent events and experiences that precipitated the admission or appointment.
What are the current stressors? Do they have any symbolic meaning?
Assess and comment on coping skills, defense mechanisms, presence or absence of cognitive distortions.
Consider current developmental demands on the person, such as marriage, divorce, birth, children leaving home, loss, aging, etc. What stage of development is the patient at now? Is it appropriate?
Social
How adequate is the patient's current support system?
What is the current status of relationships with important figures?
What are the possible peer influences?
Consider the patient's current housing arrangement.
Comment on vocational/financial status.
Comment on any relevant legal problems.
Consider the role of agencies (e.g. Veteran's Administration, Child Protective Services, Criminal Justice System) on the patient.
Comment on cultural influences that may impact the current situation and that might impact treatment.
Spiritual
Comment on the role of spirituality in the patient's life.
How does spirituality contribute to the patient's ability to hope, their position on suicide if relevant, or their contact with a supportive community?
Cultural
Comment on race or ethnicity.
Comment on the cultural factors specific to the client or family’s region of origin, language, time of immigration.
Has racism or discrimination occurred? Impact on social systems of the person.
Bio-Psycho-Social-Spiritual Model: Examples of Kinds of Questions to ask During your Interviews
When you conduct your diagnostic interviews, you will want to compile information that will allow you to address the components of the bio-psycho-social-spiritual model. It is good to start with open-ended questions in each section, narrowing to closed-ended questions if the open-ended questions do not elicit the relevant material.
Biological
Past
Genetics:
Tell me about any family history of psychiatric problems or suicide attempts.
Tell me about any relatives that have been hospitalized for psychiatric masons. Tell me about any relatives that might have suffered from emotional problems. How were they treated and how did they respond to these treatments?
History of Pregnancy and Birth:
Tell me about your mother's pregnancy with you. Do you know if she smoked, drank, or used any medications?
What have you been told about your actual birth? Were there any birth complications?
Relevant Previous Illnesses:
Tell me about any major medical problems you have had in your life. Have you had any history of head injury, endocrine disorders (i.e. thyroid, adrenal), seizures, malignancies or neurological illnesses?
Present
Current Illnesses:
Can you describe your health right now? Do you have any illnesses right now? Do you worry that you have something that has not been diagnosed?
Medications:
Tell me about the prescribed and non-prescribed medications that you are taking? (Probe for medications that have psychoactive effects, such as steroids, beta blockers, pain medications, benzodiazepines, SSRI's, Herbal remedies).
Substances:
Can you tell me about your use of alcohol or take street drugs? (Probe for whether current substance use could account for patient's psychiatric symptoms).
Psychological
Past
How were you treated as a child? (Probe for trauma as well as evidence for family strengths).
Can you tell me about any trauma's you might have experienced in life? (Probe for military/combat, rape, violence, and serious illness).
Can you describe to me any losses you have experienced? How did you cope with this?
Tell me about your relationships like with important figures, such as parents, grandparents, friends, significant teachers, or significant employers.
How have medical problems or psychiatric problems in your past influenced your life today?
Present
Tell me about the recent events and experiences that bring you here today?
How have you already tried to solve your problems? (Probe for coping skills).
How do you usually cope with difficult life-situations? (Probe for and observe defense mechanisms).
Tell me about how you are coping with marriage, divorce, birth, children leaving home, loss aging, etc. (The point here is to get a sense of what is being demanded of the person at this time, developmentally).
How do current medical problems or psychiatric problems influence your life today?
Social
Tell me about who you tum to if you need help. Do you have friends or family you can turn to if you need help?
Tell me about who you rely on for company, support, and fun. Do you have friends or family that you can rely on for company, support, and fun?
Currently, describe the kind of social life that you have? How often do you get together with people you can relate to, and do you enjoy it?
When you were feeling better, describe the kind of social life you had. How often did you get together with people you could relate to?
Tell me about your present housing arrangement? Are you satisfied with it?
Tell me about your work life. Are you working? Is your work satisfying or do you need help in this area?
Tell me about your financial circumstances?
To help me understand you, can you tell me about cultural/family beliefs that might help me get a more clear sense of your life-circumstance/symptoms right now?
Spiritual
Can you describe your spiritual belief system?
Can you tell me about how you get spiritual needs met?
Can you tell me about your religious community?
Can you describe your childhood experience of religion?
Cultural
What is your cultural/racial identity? Preferred language?
Can you tell me about your experiences of immigration? Legal status?
Is the family still together?
Any beliefs about health and social services, treatment of illness, stigma attached to seeking help
Cultural practices: holidays, celebrations, religious celebrations
Experiences of oppression and discrimination
Values and beliefs about childbearing, child-rearing, work, education
Family: gender role expectations, importance of family, role expectations of children, parents and elders.
Bio Psycho Social Spiritual Treatment Plan
The Bio Psycho Social Spiritual formulation can guide the treatment planning process. All treatment plans should include comment in the four areas and a rationale.
Biological Treatment of current illness and associated symptoms. Medications.
Psychological Individual therapy, e.g. relaxation therapy, social skills training, coping skills development. Group Therapy.
Social Assistance with housing, job training, benefits groups. Encouraging hobbies, social activities, family meetings.
Spiritual Utilise resources: Organized religious activities, Meditation/Mindfulness training, Groups.
Cultural Accommodations necessary because of cultural background
Practice Approach
Three templates based on the above information follow this section on using BPSS with people who do not speak the English language. The templates can be forwarded to interested people in .docx form. Use the 'Contact' button on the home page to request the templates.
Supporting Material
Assessing people who do not speak English
Minas, H. (2012). Specialist assessment pf people who do not speak English. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 421-422). Oxford University Press.
The following guidelines provide basic advice on administering assessment instruments with or without an interpreter to consumers with low English proficiency or who come from cultural backgrounds that are different from those in which the instruments were developed. Their focus is on mental health assessment, but some may also be relevant to the biopsychosocial assessment approach.
Assess whether the person is sufficiently proficient in English to communicate effectively about mental health issues and to demonstrate cognitive functioning.
Communication about mental health issues is one of the most challenging tasks in a second language; therefore it is important to assess English proficiency accurately.
Even if English proficiency is satisfactory, cultural factors may significantly influence consumer responses.
Knowledge and skills assessment instruments such as the MMSE and WAIS are heavily reliant on education and experience in and familiarity with the host culture.
Determine what level of education the person has received and in what country the education was received. Note that lack of education does not equate necessarily with lack of capacity. Clinicians should inquire about opportunities for education, particularly with refugees.
Immigrants and refugees from some communities may have had little or no formal education but may demonstrate sound survival skills and daily functioning. Consider alternative forms of assessment of functioning, rather than normal cognitive assessment.
Mental illness manifestations and social functioning are all influenced by culture: consider to what extent culture and the language contribute to and distort score outcomes.
When in doubt, seek cultural consultation or refer to an experienced bilingual mental health professional.
If the person has low English proficiency and the instrument is administered in English, the results may be invalid, and scores may not accurately reflect the person’s functioning.
If the person has low English proficiency, it is preferable to use pre-translated instruments that have been validated and normed for the target group. If a translated version of a test is available, establish whether it has been validated and normed for the local target group. However, in most cases such instruments will be unavailable for the person’s language and cultural group.
If an existing measure is to be formally translated, the translated instrument should be conceptually and psychometrically equivalent to and measure the same domains as the original instrument.The following are examples of templates. Different organisations have different approaches to the BPSS (or its equivalent).
Helping clients navigate religious trauma
Walsh, D., & Koch, G. (2023, November 15). Helping clients navigate religious trauma. Counseling Today. https://ct.counseling.org/2023/11/helping-clients-navigate-religious-trauma/#respond
As counsellors, we seek to support others in their search for meaning, wholeness and healing. This journey can lead us to work with clients who have had various experiences — both positive and negative — with religion and spirituality. Therefore, we must be prepared to address issues of religion and spirituality when appropriate, especially for those who have survived religious and spiritual trauma.
Many researchers in the social sciences describe religion as a shared set of practices and beliefs and spirituality as a personal relationship with God(s) or a Higher Power. Based on this understanding, an individual could experience spirituality through organized religion, be spiritual but not religious, or participate in religion but not be spiritual. An increasing number of individuals are leaving the religion they were raised in or not identifying with any religious tradition due to changing beliefs or finding community elsewhere.
The Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC), a division of the American Counseling Association, identified 14 competencies across six areas for addressing religion and spirituality in counselling. These competencies are of particular importance when working with survivors of religious/spiritual trauma to avoid further traumatization or inappropriate care.
Culture and Worldview
1. The professional counsellor can describe the similarities and differences between spirituality and religion, including the basic beliefs of various spiritual systems, major world religions, agnosticism, and atheism.
2. The professional counsellor recognizes that the client’s beliefs (or absence of beliefs) about spirituality and/or religion are central to his or her worldview and can influence psychosocial functioning.
Counsellor Self-Awareness
3. The professional counsellor actively explores his or her own attitudes, beliefs, and values about spirituality and/or religion.
4. The professional counsellor continuously evaluates the influence of his or her own spiritual and/or religious beliefs and values on the client and the counselling process.
5. The professional counsellor can identify the limits of his or her understanding of the client’s spiritual and/or religious perspective and is acquainted with religious and spiritual resources, including leaders, who can be avenues for consultation and to whom the counsellor can refer.
Human and Spiritual Development
6. The professional counsellor can describe and apply various models of spiritual and/or religious development and their relationship to human development.
Communication
7. The professional counsellor responds to client communications about spirituality and/or religion with acceptance and sensitivity.
8. The professional counsellor uses spiritual and/or religious concepts that are consistent with the client’s spiritual and/or religious perspectives and that are acceptable to the client.
9. The professional counsellor can recognize spiritual and/or religious themes in client communication and is able to address these with the client when they are therapeutically relevant.
Assessment
10. During the intake and assessment processes, the professional counsellor strives to understand a client’s spiritual and/or religious perspective by gathering information from the client and/or other sources.
Diagnosis and Treatment
11. When making a diagnosis, the professional counsellor recognizes that the client’s spiritual and/or religious perspectives can a) enhance well-being; b) contribute to client problems; and/or c) exacerbate symptoms.
12. The professional counsellor sets goals with the client that are consistent with the client’s spiritual and/or religious perspectives.
13. The professional counsellor is able to a) modify therapeutic techniques to include a client’s spiritual and/or religious perspectives, and b) utilize spiritual and/or religious practices as techniques when appropriate and acceptable to a client’s viewpoint.
14. The professional counsellor can therapeutically apply theory and current research supporting the inclusion of a client’s spiritual and/or religious perspectives and practices.
The impact of religious/spiritual trauma
Religion and spirituality can have a positive impact on overall well-being, but they can also be harmful, damaging or traumatic. Religious/spiritual trauma is similar to other types of trauma, and it can overlap or co-occur with physical, sexual or emotional trauma. However, religious/spiritual trauma can be a particularly life-altering experience because religion and spirituality are often lenses through which people view the world. Religious/spiritual trauma can thus impact a person’s sense of identity, their core beliefs and values, and their perception of safety in the world. Moreover, it can deeply alter or damage an individual’s relationship and previous understanding of that which they consider to be sacred. Because religious/spiritual trauma can deeply impact clients’ mental health, counsellors have a responsibility to develop the knowledge, skills and awareness to support clients who have experienced this type of trauma.
Working with clients experiencing religious/spiritual trauma
Like with other forms of trauma, individuals who experience religious/spiritual trauma vary in their responses and reactions. Some clients may try to preserve their previously held religious/spiritual beliefs, while others may change or abandon their beliefs. As counsellors, we may see clients who are conflicted or who do not know how they want to respond to the religious/spiritual trauma.
Key components of care for clients who have experienced religious/spiritual trauma include the following:
Cultivate safety through a trauma-informed approach. When clients have experienced religious/spiritual trauma, they often have a natural and automatic instinct toward self-protection and preservation that may be expressed as guardedness within the therapeutic space. Counsellors must carefully consider how they build the therapeutic relationship and create safety with this population. Seemingly small considerations such as asking permission and allowing clients a sense of control can have a significant impact. “I’m curious about how that experience felt to you. Would you feel comfortable sharing more about it?”
Perform an initial and ongoing assessment of risk. It is extremely important for counsellors to assess the client for risk of suicide, self-harm and other safety concerns. This risk assessment should be conducted during intake and accompanied by appropriate follow-up assessments, including assessing if the client is at risk for further religious/spiritual trauma. It is helpful to get a broad sense of what the trauma is, how the client understands the religious/spiritual trauma and where they currently are regarding their personal religion or spirituality, e.g. the client’s current level of engagement with religion.
Remember, regulation before intervention. Clients who have experienced any trauma (including religious/spiritual trauma) may experience symptoms of nervous system dysregulation throughout their daily lives. It is important to make sure clients are not experiencing overwhelm or flooding in the therapy space because this will inhibit the client’s ability to experience the clinical interventions as intended. Grounding and mindfulness interventions (such as progressive muscle relaxation, 5-4-3-2-1 sensation naming activities or gentle stretching) can be helpful when working with this population. For example, the counsellor could ask the client to rate their level of distress on a 10-point scale (least distressed to most distressed) before, after and at various times during a session if the client shares something about the traumatic experience. Pausing and conducting grounding exercises may be appropriate depending on the rating.