Assignment : Hernandez Family Assessment

Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues. As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.

The Assignment

Address in a comprehensive client assessment of the Hernandez family the following:

Demographic information
Presenting problem
History or present illness
Past psychiatric history
Medical history
Substance use history
Developmental history
Family psychiatric history
Psychosocial history
History of abuse and/or trauma
Review of systems
Physical assessment
Mental status exam
Differential diagnosis
Case formulation
Treatment plan

Note: For guidance on writing a comprehensive client assessment, refer to pages 137–142 of Wheeler (2014) in this week’s Learning Resources.

Note: Any item you are unable to address from the video should be marked “needs to be added to” as you would in an actual comprehensive client assessment

Running head: WEEK 2 ASSIGNMENT 1 1

WEEK 2 ASSIGNMENT 1

Week 2: Family Assessment and Phases of Family Therapy

NURS 6650: Pyschotherapy with Groups and families

Purpose: The purpose of this paper is to complete a comprehensive client assessment based on the videos provided in the resources of the Hernandez family. Relevant and significant information will be included along with a case formation and treatment plan on how we can would generally assess and care for the family and the situation. Assessment is as essential to family therapy. Assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues. As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.

Demographic Information: This family is a Latino American family. Mother and father are in their late 30’s. They have two sons, 8 and 6 years old respectively. The family is low socioeconomic status.

Presenting Problem: The couple was informed by a case worker that they must attend parenting classes based on their current parenting style.

History of Present Illness: The parents present to the office feeling uneasy and concerned about being mandated to attend parenting classes, however, the couple fears that if they do not attend, their children will be taken away from them by social services. The parents believe they do a good job parenting their children, but they do believe in disciplining their children when necessary which may be stricter than other styles of parenting based on their culture and the way they were raised. The couple denies any physical abuse. The parents voiced concerns stating that the classes are only offered one night a week which interferes with the father being able to work overtime preventing the family from being able to pay the bills. The worker for this case expressed concerns to her supervisor in the last video stating that their ACS worker often referred to the family as “those Mexicans.” This made her feel uncomfortable, especially after speaking with the parents and hearing their perspective, which led her to believe that the social worker was being racist or bias towards the family.

Medical History: Needs to be added to.

Psychosocial History: The family does not have a lot of money. The father often works overtime for the family to be able to pay the bills. Needs to be added to.

History of Abuse/Trauma: There is no history of abuse or trauma in the family that is known. The father simply states that he believes disciplining his children, but clarifies the fact that the parents never hit or physically hurt their children. Needs to be added to.

Review of Systems: A review of systems is unable to be provided from the information provided in the videos.

General: The family reports being frustrated by their mandate to attend parenting classes as they do not see anything wrong with their parenting style. They appear worried as evidenced by their expressed fears of not being able to work overtime on the days when they have to attend parenting classes stating that extra work is how they can afford to pay the bills.

Eyes, Ears, Mouth, Head/Neck: Needs to be added to.

Pulmonary: Needs to be added to.

Cardiovascular: Needs to be added to.

Gastrointestinal: Needs to be added to.

Genitourinary/ OBGYN, Breast: Needs to be added to.

Neurological: Needs to be added to.

Endocrine: Needs to be added to.

Infectious Diseases: Needs to be added to.

Musculoskeletal: Needs to be added to.

Mental Health: Needs to be added to.

Skin and Hair: Needs to be added to.

Mental Status Exam: Family is alert and oriented x4.

Differential Diagnosis: Needs to be added to.

Case Formation and Treatment Plan: The case formation is to meet with the parents one last time to inform them that it is understood that they are used to working overtime hours at this time, but if they do not want to lose their children, they must attend the required classes before it is too late. Helping the parents come to the conclusion of which they find more important at this time, if they find making the overtime money more important or following the requirements and attending the parenting classes to avoid having their children taken away from them. Recognizing the potential benefits of the classes related to improved child behavior and improved relationships may help them to partially eliminate their negative mindset about the idea of it (Gray, 2018). Placing more attention on the children to acknowledge that these programs can be helpful for children to reduce behavioral difficulties or who may be at risk for developing behavioral, emotion, or social difficulties could be a strategy to help them so they do not feel attacked or judged on their parenting style (Lindsay & Totsika, 2017). It will also be important to let the parents know they are justified to feel upset with being mandated to attend classes, however, the consequences can be severe if they do not attend as required. The parents should be reminded that child maltreatment, without accusing them of it, is not treated lightly.

In addition, suggesting to the supervisor that it is difficult for parents to attend with only one class time option, and that making the classes to be more flexible with families’ schedule could improve the data to support the groups. Barriers that effect program participation can include scheduling which can increases parenting stress resulting in decreased compliance, limited benefit, and attrition (Rostad, 2018). I would also like to talk to ACS worker directly to ask her what she believe to be so wrong with the couple’s parenting style, along with pointing out that biased comments were made

References

Gray, G. R., Totsika, V., & Lindsay, G. (2018). Sustained Effectiveness of Evidence-Based

Parenting Programs After the Research Trial Ends. Frontiers in psychology, 9, 2035. https://doi.org/10.3389/fpsyg.2018.02035

Lindsay, G., & Totsika, V. (2017). The effectiveness of universal parenting programmes: the

CANparent trial. BMC psychology, 5(1), 35. https://doi.org/10.1186/s40359-017-0204-1

Rostad, W. L., Moreland, A. D., Valle, L. A., & Chaffin, M. J. (2018). Barriers to Participation

in Parenting Programs: The Relationship between Parenting Stress, Perceived Barriers, and Program Completion. Journal of child and family studies, 27(4), 1264–1274. https://doi.org/10.1007/s10826-017-0963-6

Hernandez Family Episode 1

Hernandez Family Episode 1 Program Transcript

JUAN HERNANDEZ: But we didn’t do anything wrong. That woman, that social worker, who came to our house, I told her, me and Elena, we decide what’s best for our boys, not her. Telling us we punish to hard. She doesn’t know anything about us.

ELENA HERNANDEZ: We give our sons a good life. We love them very much. It’s not fair what she said about Juan and me. We’re good parents.

FEMALE SPEAKER: Mrs. Hernandez, I understand how difficult this is for you–

JUAN HERNANDEZ: I don’t think you do. Everything that we do, we do for them, everything. We work hard. We take care of them. And when they don’t follow the rules, they get punished, strictly. The old fashioned way.

ELENA HERNANDEZ: Shh. Quiet. I told you.

JUAN HERNANDEZ: Sometimes I’m not strict enough with them. Look, I punish my sons the way I see fit. That’s the only way they are going to learn. That’s how we learned from our parents, right? Nobody took parenting classes. That’s ridiculous.

FEMALE SPEAKER: I understand you’re angry. And you’re raising your children the way you were brought up to do. But ACS has required that you do this.

JUAN HERNANDEZ: What if I don’t want to be required?

ELENA HERNANDEZ: I have a question.

FEMALE SPEAKER: Of course.

ELENA HERNANDEZ: If we go through with this, the things we talk about with you, will it be private?

JUAN HERNANDEZ: But we have not agreed to do this.

ELENA HERNANDEZ: I don’t want to be here either. But I don’t want to loose our children. Would it be private, what we talk about?

FEMALE SPEAKER: The information we share is between us. The only exception to that is if one of you says you’re going to hurt yourself or hurt someone else. In that case, I have to report it to the ACS worker. But everything else is strictly confidential.

Hernandez Family Episode 1

So how do you think we can work together to make this a positive experience for both of you?

JUAN HERNANDEZ: Parenting classes, really? What about the bills? I’m not going to be able to work overtime.

ELENA HERNANDEZ: If we do what we’re supposed to do, would it be OK with our family?

FEMALE SPEAKER: There are no guarantees. But here’s what I can say. We’ll all work together to create a plan based on what the ACS worker has required and recommended. Then it will be up to her what the outcome will be.

So shall we make a plan?

Hernandez Family Episode 1 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 2

Hernandez Family Episode 2 Program Transcript

FEMALE SPEAKER: It’s good to see all our parents again tonight. And I want to say thank you for being here these last few weeks. Today, we’re going to talk about child development, specifically the behavior of our children, and what are some realistic expectations we can have about how they behave, depending on how old they are.

Part of understanding human behavior is looking at where someone is in their life, as well at the impact of their environment, whether it’s school, home life, family, or friends.

MALE SPEAKER: What’s there to understand? I mean, come on. They’re kids. They shouldn’t be seen or heard, right?

FEMALE SPEAKER: We all want our children to behave. But throughout childhood, there are certain behaviors that come with certain ages that can be very challenging to deal with.

FEMALE SPEAKER: Tell me about it.

FEMALE SPEAKER: So let’s talk about some of your expectations about your children’s behavior.

MALE SPEAKER: Well, my son is nine. That age, I expect him to do his chores and listen to me. When I was nine, you better believe I was listening to my old man, or else, you know?

MALE SPEAKER: You’ve got that right. And I don’t understand why my son doesn’t listen to me when I tell them to do something. I mean, what if I didn’t listen and come to this class? We might lose our kids. How do I deal with this better? I mean, get him to listen and behave?

FEMALE SPEAKER: Well, Juan Junior is eight, and at that age, their attention can be really hard to not only gain, but–

Hernandez Family Episode 2 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 4

Hernandez Family Episode 4 Program Transcript

FEMALE SPEAKER: So how’s your week going? What’s happening with that Hernandez family? That’s their name, right? You were having some challenges there?

FEMALE SPEAKER: They’ve missed four of their parenting classes, so far.

FEMALE SPEAKER: So they haven’t completed the parenting group?

FEMALE SPEAKER: I have to call the ACS worker and let her know. They’re probably going to have to take the classes over again, and that’s going to be tough. The father misses overtime to come to the classes, and they really rely on that money to make ends meet.

FEMALE SPEAKER: You have something else on your mind. Say it.

FEMALE SPEAKER: I should have discussed this with you earlier. I don’t know why I didn’t. But perhaps they weren’t the best candidates for this to begin with.

FEMALE SPEAKER: Because of their financial situation?

FEMALE SPEAKER: Yes, and something else. I remember the ACS worker. And when she talked about wanting Elena, she kept calling them Mexicans. It was really derogatory the way she said it.

FEMALE SPEAKER: So you’re saying she might have been biased into mandating that they take these classes?

FEMALE SPEAKER: Yes. The more I think about it, she never talked to me about trying to understand the way they’re raising their children. And that Mexican remark, it just really wasn’t respectful. It’s like she had already made up her mind about people from that culture, and now they’re paying the price for it.

Hernandez Family Episode 4 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 4

Hernandez Family Episode 4 Program Transcript

FEMALE SPEAKER: So how’s your week going? What’s happening with that Hernandez family? That’s their name, right? You were having some challenges there?

FEMALE SPEAKER: They’ve missed four of their parenting classes, so far.

FEMALE SPEAKER: So they haven’t completed the parenting group?

FEMALE SPEAKER: You have something else on your mind. Say it.

FEMALE SPEAKER: I should have discussed this with you earlier. I don’t know why I didn’t. But perhaps they weren’t the best candidates for this to begin with.

FEMALE SPEAKER: Because of their financial situation?

FEMALE SPEAKER: Yes, and something else. I remember the ACS worker. And when she talked about wanting Elena, she kept calling them Mexicans. It was really derogatory the way she said it.

FEMALE SPEAKER: So you’re saying she might have been biased into mandating that they take these classes?

Hernandez Family Episode 4 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 5

Hernandez Family Episode 5 Program Transcript

FEMALE SPEAKER: They’ve missed four of their parenting classes so far.

FEMALE SPEAKER: So they haven’t completed their parenting group?

FEMALE SPEAKER: I have to call the ACS worker and let her know. They’re probably going to have to take the classes over again, and that’s going to be tough. The classes caused the father to miss overtime at work, and they really rely on that money to make ends meet.

FEMALE SPEAKER: But they have to finish the program. They’re only allowed three missed classes. There’s another problem. You know the agency’s been conducting a study of our performance. Well, it lowers our completion numbers. Lower numbers put our funding at risk. Our bosses start questioning the credibility of what we’re trying to do here.

FEMALE SPEAKER: But I can’t give the Hernandez family the post test. They won’t be able to complete it.

FEMALE SPEAKER: No, that’s not why I brought this up. The agency needs data to determine how effective these parenting classes are. The more attrition we have when parents don’t finish the program, there’s no data. No data means no support for what we’re teaching or how it might benefit other populations.

FEMALE SPEAKER: Maybe we should account for the attrition then. Maybe there’s something we can learn from it?

Hernandez Family Episode 5 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 6

Hernandez Family Episode 6 Program Transcript

FEMALE SPEAKER: So last week I showed you how to make a genogram, like this one. Now, the idea behind making a genogram is to help you draw a picture of your family history. And then we use that to discuss the relationships and connections among your relatives. OK? So Juan, why don’t you start off and talk about what you came up with.

JUAN HERNANDEZ: So we’re starting with my family. My father, Hector, he’s still alive. And he married my mother, Freda. And she passed away two years ago. And then there’s their children, myself– I’m the oldest– and then there’s my three sisters, Marie, Senta, and Rose.

FEMALE SPEAKER: Good. And Elena, what about your family?

ELENA HERNANDEZ: Well, here’s my father, Anthony. He met and married my mother, Sofia. They are both still alive. They had five children. Firstborn was my brother Daniel, then my brother Tomas, then my sisters Martina and Camila, and there’s me, the baby.

And then I met Juan, and we started our own family. And we have two beautiful sons that you met, one, Junior, who is eight, and Alberto, who is six.

FEMALE SPEAKER: Good. So for the last several weeks we’ve been talking a lot about how you discipline your sons at home. And both of you mentioned how your parents used to punish you when you were growing up. Juan, why don’t you talk about that and point to anybody on the genogram as you mention them?

JUAN HERNANDEZ: Sure. So my dad, when he was mad at me he would send me to get books from the encyclopedia. And he’d make me hold them out, straight out like this, until he told me to stop. It caused so much pain in my arms, I mean, my arms felt like they would break off.

And my mom, she did basically the same thing. Except when she was really mad, when would make me get more books than my dad. I hated those books so much. I never went near them on my own. To me, they only meant one thing, misery. And now, I guess I inherited that from them.

FEMALE SPEAKER: Elena, how about you?

ELENA HERNANDEZ: Yes, misery. That’s what it was like for me, too.

Hernandez Family Episode 6

Hernandez Family Episode 6 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Assignment : Hernandez Family Assessment

The Assignment

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