Comprehensive Family Assessment

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Demographic information: Juan and Aleena Hernandez are a middle-aged, married, Hispanic couple.  Mr. and Mrs. Hernandez have two biological children; Juan Jr. age eight and Alberto age six.  Mr. Hernandez is employed full-time and frequently works overtime due to financial stressors.  Additional information is needed regarding his occupation.  Additional information is also needed regarding Mrs. Hernandez’s employment status.

Presenting problem: 

Per B.A. (father), “All my son wants to do is lay around and be lazy, he needs to get a job and get off the couch.”

Per J.A. (son), “My dad and I just don’t see eye to eye, he isn’t supportive of anything I say or do.  He never was, and he never will be.”

History or present illness:  ather and son present for therapy following a referral from Additional and detailed information is needed regarding ACS’s concerns related to the couples parenting style and current disciplinary strategies.  Mr. and Mrs. Hernandez deny utilizing any physical forms of discipline.

Past psychiatric history:  Information regarding psychiatric history for both Mr. and Mrs. Hernandez needs to be obtained.  Family history of psychiatric illness or diagnoses must also be obtained.  No overt signs of psychosis or impaired thought process is noted during interactions with Mr. or Mrs. Hernandez.

Medical history:  A thorough medical history must be obtained for both parents and both children.  Both paternal and maternal family medical history is also needed.

Substance use history:  Substance use/dependence history must be obtained for both parents.

Developmental history:  Both Mr. and Mrs. Hernandez participated in a genogram exercise.  Mr. Hernandez is the oldest of four children and was raised by both biological parents.  He reported the death of his mother two years ago.  Additional information regarding his relationship with his father is needed.  He described being disciplined as a child as “misery.”  He was able to recall a detailed description of how he was disciplined as a child.  Mr. Hernandez reported that he was made to hold his arms straight out and that book were placed on his arms for him to hold.  Additionally, he expressed his belief that “it is the parents’ job to discipline their children as they see fit” (Laureate Education (Producer), 2013a).

Mrs. Hernandez is the youngest of five children in her family.  Additional information regarding her childhood family dynamic and primary caregivers is needed.  Mrs. Hernandez stated that both of her parents are alive.  She did not provide any specific or detailed accounts of the disciplinary style her parents embraced, yet she did seem to imply that she was disciplined similarly to Mr. Hernandez.  Additional information is needed related to Mrs. Hernandez’s childhood.

Family psychiatric history:  Information regarding family psychiatric illness and substance use are needed.

Psychosocial history:  Additional information is needed including where the family lives, any additional family members, friends, or pets residing in the home, school the children attend, current grade and academic interventions, attendance record, after school activities, religious affiliation or participation, extended family interactions and involvement, parent’s educational status, and social/leisure activities.  Financial stressors have been expressed by both Mr. and Mrs. Hernandez.  The significance of Mr. Hernandez’s ability to work overtime and the impact that this has on the family’s financial situation was stressed by the couple.

History of trauma and abuse:  A thorough history of trauma, neglect, physical, sexual, and emotional abuse needs to be collected for both Mr. and Mrs. Hernandez.  Neither parent disclosed any history of abuse however this topic warrants further discussion.

Review of systems:  A ROS needs to be obtained for both parents and both children.

Physical assessment:  Mr. and Mrs. Hernandez do not appear or express any physical limitations or chronic health conditions.  They both appear well kempt, hydrated, and nourished.  Detailed physical assessment must be obtained with any pertinent findings evaluated for possible contribution to strained family dynamic.  Both children appear clean, hydrated, well nourished, and absence of any obvious physical limitations.  Pediatrician medical records to be obtained for reference, relevance, or contribution.

Mental status exam:  Both Mr. and Mrs. Hernandez are able to articulate their thoughts effectively.  No signs of illogical or impaired thought process is noted when interacting with either parent.  Appropriate expression of emotion is noted for both parents.  They present with an appropriate demeanor and affect, are cooperative and participative with interactions, and show appropriate affection towards each other.

Differential diagnosis: 

  • 20 Parent-Child Relational Problem (American Psychiatric Association [APA], 2013).
  • Rule out 995.51 Child Psychological Abuse Suspected (APA, 2013).
  • Rule out V61.22 Encounter for mental health services for perpetrator of parental child psychological abuse (APA, 2013).

Case formulation:  Mr. and Mrs. Hernandez present as loving parents and verbalize their commitment to completing the ACS required parenting classes for fear of further involvement or losing their children.  Financial barriers may impede the family’s ability to be compliant with parenting classes and should be analyzed for risk, benefit, and consideration of a better suited intervention.  Learned behavior, cultural influence, and lack of insight as it relates to emotional wellbeing seem to be the couples’ weakness.  Mr. Hernandez verbalizes belief in ridged boundaries when it comes to disciplining his children and is supported by his wife.  These is no evidence of suspected physical abuse at this point however a detailed account of the ACS workers rationale for mandating parenting classes is needed.  Further, physical assessment of both children must be obtained if abuse is suspected by the ACS worker.

Treatment plan: 

  • Referral to
  • Referral to individual psychotherapy for both mother and adolescent.
  • Obtain additional clinical information in areas mentioned above.
  • Follow-up with Children and Youth regarding outcome of open case.

Summary

In summary, accurate assessment of family dynamics requires self-awareness of one’s own biases, professional insight, active and empathetic listening, and cultural competence.  Cultural beliefs influence parenting style and behavioral expectations and must be taken into consideration when establishing a therapeutic alliance and in developing a well-suited treatment plan.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

Perese, E. F. (2012). Psychiatric advanced practice nursing: A biopsychosocial foundation for practice. Philadelphia, PA: F.A. Davis Company.

Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.