David, in response to this sentence, “I have never conducted extensive assessments for spiritual distress. In this light, I haven’t analyzed interviews as suggested in the model. Nor have I quantified unmet needs numerically. Is this being done by colleagues in the forum”  I’m with you in that I don’t do much formal, extensive kind of assessments for spiritual distress and I really have a struggle with idea of trying to quantify to the work of the chaplain.  I used to do some per diem chaplaincy at our local hospital and they started asking the chaplains to keep track of how many visits, length of each and some sort of measure for the depth or significance of the problem addressed.  My experience tells me that some of our best work might come in the form of a brief, hallway conversation as opposed to a longer, more formal kind of conversation/intervention/interview.  I also know the opposite can be true in that it may take a longer time and more focused, structured questions to get to the heart of the matter.  These kind of realities cause me to question the value of trying to quantify our work.   Likewise, with assessments, in the LTC setting we have the opportunity to get to know people over the course of time and through the process of walking together through various crises and blessings.  This reality allows us to build an assessment, so to speak, rather than do an assessment.  In the moment of crisis some level of assessment may be needed but I’m just not sure that a one size fits all assessment is always going to be accurate.  Perhaps that leads to the question of do we need different assessments for different situations.  I don’t know that I have the answer for that.   Sorry, I’ve taken to rambling which may very well indicate that I really do struggle with the idea of trying to quantify and organize our work which is filled with the mysteries of God and spirituality and the complexities of human lives.  Maybe the ministry of presence is the best thing we can bring to the table.