Department of Psychiatry and Behavioral Sciences University of Nevada, Reno School of Medicine Bio-Psycho Social-Spiritual Model In all our teaching, we invite students to conceptualize patient problems by using a bio-psycho-social-spiritual formulation. This model is used throughout our curriculum in psychiatry. We ultimately want students to arrive at patient formulations that allow for understanding and drive formation of treatment plan. Formulations help explain "how did this patient get to this psychiatric status?" What follows is a description of the components of the bio-psycho-social-spiritual formulation. We have added prompts for the students to help them think about and organize clinical material. Students are encouraged to include each component in formulations. This model generally includes the following: Biological Past Genetics: Consider whether any blood relatives that have had psychiatric problems, substance use problems or suicide attempts/suicides. Is there a history of close relatives who have been hospitalized for psychiatric reasons? What kind of treatments did they get, how did they respond? 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 Consider any history of head injury, endocrine disorders (e.g. thyroid, adrenal), seizures, malignancies, or neurological illnesses. Consider potential lasting effects of past substance use on brain functions such as cognition, affective regulation, etc. Present Current Illnesses: Identify current illnesses and any direct impact they may have on psychiatric presentation. Medications: Assess current medication regimen. Consider whether these medications have psychoactive effects (e.g. steroids, beta blockers, pain medications, benzodiazepines, SSRI's, antipsychotics). 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 (child abuse, combat, rape, serious illness), as well as resiliency (how the patient coped with trauma, e.g. friends, family, religion). 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. Comment on how past medical problems, substance use or psychiatric problems impacted the patient's development and their relevance to patient today. Present Describe the recent events and experiences that precipitated the admission or appointment. What are the current stressors? Do they.

1. Department of Psychiatry and Behavioral Sciences
University of Nevada, Reno School of Medicine
Bio-Psycho Social-Spiritual Model
In all our teaching, we invite students to conceptualize patient
problems by using a bio-psycho-social-spiritual
formulation. This model is used throughout our curriculum in
psychiatry. We ultimately want students to arrive
at patient formulations that allow for understanding and drive
formation of treatment plan. Formulations help
explain "how did this patient get to this psychiatric status?"
What follows is a description of the components of the bio-
psycho-social-spiritual formulation. We have
added prompts for the students to help them think about and
organize clinical material. Students are
encouraged to include each component in formulations.
This model generally includes the following:
Biological
Past
Genetics:
Consider whether any blood relatives that have had psychiatric
problems, substance use problems or
suicide attempts/suicides. Is there a history of close relatives
who have been hospitalized for
psychiatric reasons? What kind of treatments did they get, how
did they respond?

2. 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
Consider any history of head injury, endocrine disorders (e.g.
thyroid, adrenal), seizures, malignancies,
or neurological illnesses.
Consider potential lasting effects of past substance use on brain
functions such as cognition, affective
regulation, etc.
Present
Current Illnesses:
Identify current illnesses and any direct impact they may have
on psychiatric presentation.
Medications:
Assess current medication regimen. Consider whether these
medications have psychoactive effects
(e.g. steroids, beta blockers, pain medications, benzodiazepines,
SSRI's, antipsychotics). Consider
possible side effects of current medications.
Substances:
Consider the influence of nicotine, alcohol and street drugs on

3. current psychiatric symptoms.
Consider the possible effects of substance withdrawal.
Psychological
Past
Comment on any past history of trauma (child abuse, combat,
rape, serious illness), as well as resiliency
(how the patient coped with trauma, e.g. friends, family,
religion).
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.
Comment on how past medical problems, substance use or
psychiatric problems impacted the
patient's development and their relevance to patient today.
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?
What is the developmental impact of the patient's illness?
Social
How adequate is the patient's current support system?

4. 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. Is the
patient affiliated with a spiritual community
of some sort?
How does spirituality contribute to the patient's ability to hope,
their position on suicide if relevant, or
their contact with a supportive community?
Bio-Psycho-Social-Spiritual Model: Examples of Kinds of
Questions to ask During your Interviews
In the small groups and case presentations in this course, we
want students to acquire the skills that will help
you arrive at a useful bio-psycho-social-spiritual formulation.
This model is introduced in the first year and
used throughout our curriculum in psychiatry.
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.

5. What follows is a description of the components of the bio-
psycho-social-spiritual formulation. We have
added cues to help you elicit relevant material. 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 the 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

6. 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

7. 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

8. 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?
Bio Psycho Social Spiritual Treatment Plan
The Bio Psycho Social Spiritual formulation can guide the
treatment planning process. We want all of your
treatment plans, in this course and in our clerkship, to include
comment in all of the areas specified below. As
with the formulation, the treatment plan is individualized and
this guide may provide a starting point. There is
some overlap as noted below.
Biological
Diagnostic:
To "work up" current medical and psychiatric symptoms labs
(i.e. thyroid, metabolic panel, Urine Drug Screen,
blood alcohol level, current blood level of medication if
relevant) Imaging (i.e. MRI, chest X-ray) Other: EEG,
Biopsies, etc.
Therapeutic:
Treatment of current illness and associated symptoms
Medications for underlying psychiatric disorder:
antidepressant, mood stabilizer, antipsychotic, etc. Medications
related to substance use disorder:
methadone, alcohol withdrawal protocol, nicotine replacement
therapy, etc. Medications for symptom relief:

9. sleeping medication Medications for other medical problems:
antibiotics, etc. life style prescriptions such as
exercise and diet changes. Give your rationale as to why you are
or are not choosing a biological treatment for
particular problems with particular patients.
Psychological
Diagnostic:
Psychological testing: personality, IQ, other relevant tests.
Behaviors and personality styles noted in the
interview or reported by staff. Obtain more information: (old
records, speak with outside providers, family) with
written consent
Treatment:
Individual Psychotherapy: (tailored to patient — may include
behavioral treatments such as DBT, relaxation
therapy, behavioral activation, social skills training, coping
skills development or cognitive behavioral therapy
or psychodynamic therapy — be prepared to justify your choice
for this patient). Couple's Therapy/Group
Therapy: (tailored to patient, many choices, may include 12
step). Give you rationale as to why you are or are
not suggesting a type of psychotherapy. Are there any
interventions that could decrease psychological
barriers to treatment?
Social
Diagnostic:
Assessment of patient's social and financial resources,
qualifications for various aid programs (housing,
Vocational Rehabilitation, Medicaid, GA, etc.)
Therapeutic:
Assistance with housing, job training, benefits groups (may
include 12 Step, "Self-Help," Reminiscence,

10. Clubs, etc.) Encouraging hobbies, encouraging social activities,
family meetings.
Give a statement about why these kinds of supports are or are
not indicated. Are there any interventions that
could decrease social barriers to treatment?
Spiritual
Diagnostic:
Assessment of patient's past religious and spiritual affiliations.
Therapeutic:
Identifying resources: Organized religious activities,
Meditation/Mindfulness training, Groups (may include 12
step).
Give a statement about why these kinds of supports are or are
not indicated.
Other:
Inpatient vs. Outpatient Treatment (would you admit, discharge
or continue current level of care?) Legal 2000
(Does patient meet criteria?) Removal of firearms from home
Mandated Reporting (child, elder abuse? Tarasoff
considerations?)
University of Nevada, Reno School of Medicine
1664 North Virginia Street
Reno, NV 89557-0357
Clinics/Patients (775) 784-1223
Academic (775) 784-6063

11. Administrative (775) 784-6001
https://www.unr.edu/
tel:7757841223
tel:7757846063
tel:7757846001
https://med.unr.edu/
HBSE II
Dr. Norwood
Risk and resiliency paper
Hutchison summarizes social work research that has focused on
risk, protection, and resilience to
understand human behavior. Research has documented
correlates between specific
risk/protective factors and various problems. The
biopsychosocial-spiritual framework helps
social workers to conceptualize risk and protective factors in all
domains of a person’s life.
The purpose of this assignment is to convey an understanding of
the concepts of risk and
resiliency, integrate a biopsychosocial-spiritual assessment of a
client or person known to you,
and identify evidence-based intervention that may improve the
client’s resiliency.

12. Assignment Instructions:
• Choose a current or past client from your field placement or
professional agency; be sure
to protect confidentiality by changing names and other
identifying information. If you
have never worked with a client before, you may choose
someone you know or a famous
character or celebrity.
• Briefly, define the concepts of risk and protective factors and
resiliency. Explain the
relevance of these concepts to social work practice.
• Briefly, describe the agency in which you encountered this
person, the reason he/she was
seeking services, and necessary demographic information to
help the reader “know” the
client.
• The bulk of the paper should then consist of a
biopsychosocial-spiritual assessment of the
client, with a particular focus on the risk and protective factors
that are evident in his/her
life. Be sure to assess each domain in the person’s life.

13. o Identify the risk and protective factors present regardless of
whether or not they
are currently impacting or have had an impact on the
individual’s life. Discuss
overall well-being and potential functioning over the life course
if the current
trajectory continues.
o This section of your paper should also include peer-reviewed
sources to
document why you categorized these client characteristics as
risk or protective
factors.
• Identify any social and economic injustices that the client may
have experienced as risk
or protective factors. Again, use peer-reviewed sources to
document why you believe
these factors would promote or decrease resiliency.
• Provide a brief conclusion
Additional criteria:
• The paper must be in APA format and include properly
formatted title page and reference
list. An abstract is not needed.
• You must use at least 3 peer-reviewed articles. You may use

14. other properly cited
resources such as the textbook and legitimate, professional
websites, but these will not
count towards the 3- article requirement.
• The paper must be written professionally; this means that
there should be no contractions
or slang used and spelling, grammatical, and punctuation errors
are minimal. The writing
needs to be logically organized; use of an outline to follow as
you write is very strongly
encouraged. Use very clear transition sentences that indicate the
topic of your paragraphs,
and only discuss one topic per paragraph.
• The paper should be 3-4 pages in length. I will stop reading at
the end of the 4th page and
you will be graded accordingly.
• Submissions must be in .doc, .docx, or .rtf format. There will
be a 20% deduction for
every 24-hour period following the due date until the correct
format is submitted.
Grading Rubric:
• Content, 15 Points
o All criteria above are addressed.

15. o There is evidence of critical thinking.
o Mastery of core concepts is evident.
• Use of Literature, 5 Points
o Literature is current and relevant.
o Literature is incorporated into the paper fluently, without
over-use of direct
quotes, and cited and paraphrased appropriately.
o The minimum number of sources are incorporated.
• Use of APA Format and Professional Writing, 5 Points
o Adherence to APA formatting guidelines is evident.
o Writing is clear, organized, and has smooth transitions,
correct grammar,
punctuation, spelling, and professional writing.
Submit your assignments to the Turnitin.com dropbox and the
Moodle assignment box. You
must submit to both boxes! The Turnitin box will allow you to
have the ability to submit the
assignment, review the grammar and plagiarism suggestions,
and withdraw the paper to correct it
as many times as you wish prior to the due date/time. Please
take advantage of this, as there will

16. be no exceptions regarding reporting plagiarism to the Student
Advocacy and Accountability
office. Have a peer, colleague, or trusted friend review your
paper for you, also, to further
decrease the writing errors that will negatively impact your
grade.