Integrated Care Case Assessment

Integrated Care Case Assessment

Individuals' health is a critical concept in the healthcare field and fascinating regarding the interpretation and ways of managing it. Various interventions models interpret health problems differently, and as a result, they have their different ways of management. The biomedical model interprets health in terms of normal and abnormal function, starting with gene to phenotype, which guides the therapeutic and prevention interventions for human diseases (Gale, n.d.). Biomedical model characteristics are based on a reductionist approach where the illness is linked to a single cause within the human body with consideration of mental processes as a different aspect and unrelated to the identified problems. The biomedical model identifies the relationship between the causal agent and affected component to treat the individuals' components affected (Sotomayor & Gallagher, 2019). It does not consider the psychosocial-spiritual spheres that exist in humans’ life. The biopsychosocial model has an objective approach where it takes into consideration the understanding of psychological, biological, and social levels of individuals and how they correlate with medical findings (Saad et al., 2017). Biopsychosocial models believe that all its levels should be accounted for in all health care tasks. Therefore, physicians must understand and attend to the biological, spiritual, social, and psychological dimensions of the disease to respond to patients' suffering effectively. The inclusion of the spiritual aspect in the biopsychosocial model is due to its connection with illness and suffering outcomes and the need to include the totality of the patient's relational existence in the holistic health care approach (Saad et al., 2017). Therefore, individual health considers the mental, physical, social, and spiritual well-being and not just the absence or presence of a disease.

Biopsychosocial-spiritual Assessment

Biopsychosocial-spiritual assessment takes a holistic approach to evaluate patients' experiences, including their mental and physical health (Gale, n.d.). Through biopsychosocial-spiritual assessment, social workers are able to point out and evaluate patients' treatment needs. Biopsychosocial-spiritual assessment has its processes and activities, which are deployed to collect patients' contemporary circumstances, needs, and protective and risk factors within their environmental context where these factors exist. Biopsychosocial-spiritual assessment is conducted using clinical interviews and observation and by use of standardized screening tools and the review of other existing records (Sulmasy, 2002). It is based on the evaluation and understanding of patients' psychological, biological, spiritual, and social dimensions and needs.

Biopsychosocial-spiritual Dimensions Assessment

Biological factors are the physical, chemical, genetic, and neurological conditions resulting from psychological disturbances (Gale, n.d.). They include patients' genes, immune response, infections, physical traumas, hormones, and environmental toxins. The biological dimension of assessment includes evaluation of patients' medical history (past and present, including medications), family history of medical illnesses, substance abuse history, developmental history, and physical functioning and abilities.

Psychological factors are individuals' thought processes and their effects on individuals' behavior and mental states (Saad et al., 2017). These factors can impact individuals' physical well-being and vice versa. They include coping skills, personality, reaction to illness, stress, psychological traumas, and suicidal ideation. The psychological dimension of assessment includes information about any psychiatric symptoms or illnesses the client is currently experiencing or has experienced in the past, mental status, family history, psychiatric medications or treatments (past and present), and psychosocial stressors or traumatic events.

Social factors are the aspects of social context that affect individual behavior and thought. They include family relationships, religious background, marital status, social support, living situations, financial status, hobbies, and recreational activities (Hardie, 2021). The social dimension of assessment includes information on the client's social functioning, living situation, personal and family relationships, sexuality, family background, history of abuse, educational background,  legal history, employment history, potential risks, and strengths and resources available to support the client.

The spiritual dimension of assessment considers patients' spiritual state in their lives and how it impacts individuals' ability to hope, their view on suicide, and their connection to the community (Saad et al., 2017). The assessment includes information on the client's spiritual beliefs, participation in faith-based activities, connections to organized religion, and spiritual practices and resources (Hatala, 2021). A comprehensive biopsychosocial-spiritual assessment (such as the one done on Joseph) includes the above dimensions to describe the health state of patients to facilitate effective intervention and treatment plans.

Key Questions for Biopsychosocial-spiritual Assessment

While assessing the different dimensions of the biopsychosocial-spiritual model, there are key questions that assist in highlighting the details sought. These questions are asked during clinical interviews, and they are specific to each dimension being assessed.

In biological dimension assessment, some of the key questions include the following: Do you have a current primary care physician? Who is she/he? Currently, are you under medication? What are they? Personally, do you have a history of substance abuse? Which medical problems are you currently experiencing that might be impacting your life? Do you have a history of surgical or medical issues? Describe to me your health right now? Do you think you have an undiagnosed problem?

Some of the key questions in psychological dimension assessment include: What problem brought you here today? How long have you been experiencing the problem? What are your main weaknesses and strengths? Have you ever attended counseling in the past? What do you think is your greatest need right now? Describe your relationship with influential figures such as your friends, parents, wife, and significant employers and employees? Have you tried to find solutions to your problems? In a difficult life situation, how do you cope? How are you coping with children, marriage, aging parents, and your lack of social connections?

On social assessment, the questions include: Who do you turn to when you need help? Are your friends or family available when you need help? Who depends on when you want to support, company, and have fun? Is your family or friends available for that? Describe to me your social life. Describe to me the kind of social life you had when you felt better. How is your work life? What about your financial circumstances?

On spiritual dimension assessment, the key questions are: What is your spiritual belief system? How do you get your spiritual needs met? Do you have a religious community? Describe it. How was your childhood experience of religion? Describe it.

Key Individuals in Biopsychosocial-spiritual Assessment

A biopsychosocial-spiritual assessment process assumes a collaborative approach. It includes professions from different fields that are determined by the dimensions under assessment (Saad et al., 2017). The role of each professional representative is defined by their specific dimensions. Physicians and nurses are mostly focused on the biological aspect where they evaluate the medical problems presented, the patient's medical history, the type of medications they are currently using, and interpretation of previous medical records. Psychologists are focused on the psychological aspect of the patient. They evaluate and interpret how different psychological factors in patients' life might be causing psychological disturbances which have an adverse impact on individuals' health. Spiritual leaders guide in the spiritual assessment by identifying potential conflict factors to spiritual well-being and coming up with spiritual interventions. Sociologists guide social and cultural assessment, identifying potential areas of conflict.

Joseph’s Biopsychosocial-spiritual Assessment and Intervention

Joseph is a married man, 47 years old, and has two children. He has had a remarkable career as a computer engineer, and he is well respected in his company. Joseph has been a religious man since high school when he was a Christian Union leader. Until recently, when he had an interaction with a coworker who made him question his faith, among other important details in his life, his faith was strong, and he had a purpose in life. However, currently, he has had numerous questions, including about his self-worth and faith. After the doubts were installed in his head by a coworker, he started suffering from headaches and frequent stomachaches, and he has been unable to sleep well for the last few months. His relationship with his wife is conflictual, but he has a close relationship with his elderly mother, who has liver cancer. Joseph does not have an active social life, a trend he developed back in high school.

The results of the biopsychosocial-spiritual assessment show Joseph's biological, psychological, social, and spiritual issues or concerns. These issues are intertwined, and they are adversely impacting his health. His inactive social status means he barely shares his struggles with anyone, and when it comes to her wife, it is all conflict. His mother, who happens to be his closest friend and family, has liver cancer at an advanced age, which means she is close to leaving him, a realization that potentially impacts his psychological well-being. He could have sought support and clear meaning in life from his spiritual allegiance, but the conversations with a coworker compromised that chance. The well-being of Joseph in four dimensions is compromised, and he is in a health crisis. To help Joseph develop attainable and helpful goals is a collaborative effort that will require intervention from the four dimensions (psychological, social, biological, and spiritual). He needs to get his faith back and intact to help make peace with her mother's situation, which might be contributing to his conflicts with his wife. He also needs to extend his social support so that he can share his life frustrations. The above interventions with referrals to relevant professionals will assist Joseph in finding his worth back.

Integrated Treatment Plan

The best-integrated treatment plan for Joseph should be a collaborative effort of different professions (physician, social workers, nurses, psychologists, and spiritual leaders). It should entail treatment plans and treatment of struggles as highlighted by biopsychosocial-spiritual assessment (Peteet, 2012). Joseph's spiritual well-being seems to have been the reason he was coping with psychological, social, and biological struggles. When his spiritual well-being and stability were disturbed by his interaction with a coworker, the defining components of his health came tumbling down. The integrated treatment plan should identify and address the prevention areas such as lack of social support, doubts about faith and self-worth, and psychological meltdown. The intervention should be based on assessment results of biopsychosocial-spiritual dimensions, and they include restoration of faith, finding the meaning of life to restore self-worth, finding social support, and restoration of lost marriage confidence.

Student Add-In

When Joseph was in high school, he was smart and had a solid Christian faith. His father left while he was young. His mother never remarried and struggled to raise him with his two siblings. He joined the college on scholarship, where he excelled in computer engineering studies. Joseph has been socially inactive since, although while in high school, he was a Christian union leader. 

References

Gale, L. (n.d). Biopsychosocial-Spiritual Assessment: an overview https://www.ebsco.com/sites/g/files/nabnos191/files/acquiadam-assets/Social-Work-Reference-Center-Skill-Biopsychosocial-Spiritual-Assessment.pdf

Hardie, M. (2021). Three Aspects of Health and Healing: The Biosychosocial Model In Medicine. https://surgery.wustl.edu/three-aspects-of-health-and-healing-the-biopsychosocial-model/

Hatala, A. R. (2013). Towards a biopsychosocial–spiritual approach in health psychology: Exploring theoretical orientations and future directions. Journal of Spirituality in Mental Health, 15(4), 256-276.

Peteet, J. R. (2012). Spiritually integrated treatment of depression: A conceptual framework. Depression research and treatment, 2012.

Saad, M., De Medeiros, R., & Mosini, A. C. (2017). Are we ready for a true biopsychosocial–spiritual model? The many meanings of “spiritual”. Medicines, 4(4), 79.

Sotomayor, C. R., & Gallagher, C. M. (2019, March). The team based biopsychosocial model: Having a clinical ethicist as a facilitator and a bridge between teams. In HEC Forum (Vol. 31, No. 1, pp. 75-83). Springer Netherlands.

Sulmasy, D. P. (2002). A biopsychosocial-spiritual model for the care of patients at the end of life. The gerontologist, 42(suppl_3), 24-33.