Screening for the Unknowns

The “Medical Family Therapy: Cross Cultural Implications” course that I taught in Swaziland on the campus of African Christian College in August and September had a number of modules. Some modules were just read, think, and apply.  Other modules were heavy on application. One of those modules was on the use of screening inventories in behavioral health settings.

Screening inventories are used to rule out things that are not there and to rule-in things that are there and demand clinical attention. They are most frequently brief inventories. Preferably, they are less than ten or so items.  The inventories we learned were the ACE(Adverse Childhood Experiences), the PHQ-2 and PHQ-9 (measuring depression), the GAD-7 (measuring anxiety), the ORS/SRS system of Dr. Scott Miller which measures the challenges of the person since the last session as well as the evaluation of the session that is just ending. We gave some attention to the Marital Attitudes Scale and a recent publication by Hinson, Hargrave, Northrup, and Robertson (2017) though it is longer, i.e., 48 items that assesses the client’s commitment to the marital relationship.

The learning process included reviewing the literature, hearing me lecture on each screening inventory, and then completing, scoring, and interpreting the results on oneself. We then role-played giving each inventory to a client. This was no small task as the students were learning the inventories for the first time as well as processing one’s own unresolved issues. Obviously, we spent much time discussing the scores, their ratings as low, moderate, and high, and how to address personal concerns.

In view of our stated theological orientation of bring shalom into a broken world, these inventories and the students’ abilities to use them and use them well can help to create shalom for people who are broken or broken hearted. The inventories do not address how well one is, but rather how wounded one is.  On the one hand, the absence of a high score, or the presence of a low score suggests that one is doing well in terms of that which the inventory measures, but in integrated healthcare settings, people are generally going to be more troubled than less troubled.

If a therapist knows what the problems are, then a collaborative relationship can be created so as to address the issues. A caring, compassionate, and fully informed clinician can ease a client’s anxieties about discussing matters that are personal. A person who is trained in how illnesses can impact the family can be useful on the “front-line,” so to speak of the health and well-being of clients.

 

 

The students seemed to gravitate to Dr. Scott Miller’s ORS/SRS system. Here is the link for more information on this topic: https://www.centerforclinicalexcellence.com/. Dr. Miller gave the students permission to download and use his materials and the students were thankful for the access to these materials. The Outcomes Rating Scale is simply a four-item, ten-point Likert scale, inventory that the client fills out immediately prior to the consultation.  This inventory assesses the challenges of the person’s life and it orients the therapist toward what needs to be worked on.  At the end of the consultation, the Session Rating Scale is completed.  Again, it is a four-item, ten-point Likert scale inventory that assesses the quality of the therapy session that is just ending. This is immediate feedback from the client to the therapist and helps to keep the process positive and constructive.

The ACE, or Adverse Childhood Experiences, inventory could be pivotal for their settings and homelands.  There is must loss, conflict, and trauma that defines the worlds from which students come.  They are familiar with suffering and grief.  They learned that the more trauma a person experiences in his or her life prior to the age of 18, the greater the probability of experiencing various medical conditions.  Addressing just the medical conditions is inadequate.  It is imperative that clinicians address the underlying trauma that prompted the rise in the number and severity of the medical conditions.

These students love their homelands, their church, and the Lord. They are convicted about serving God these unique ways when they return home. These tools are a hands-on way of serving the needs of people by assessing their lived experiences.  When they do so, they are bringing about shalom in their broken worlds.  How our world needs shalom.  Shalom in Africa and shalom in America. That is exactly what we all need.