Hernandez Family Assessment

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FAMILY ASSESSMENTS

Comprehensive Client Assessment of the Hernandez Family

 

Comprehensive Client Assessment of the Hernandez Family

            A comprehensive assessment of the client is needed to assess and evaluate a client’s condition. It is an important tool because it enables practitioners to be able to observe their clients, note their signs and symptoms and also help them establish a therapeutic relationship with their clients. This assessment tool when done correctly, it can enhance a clients’ treatment success as it documents the client’s history of illness, psychosocial or personal history, their current mental status, cognitive assessment, physical assessment, any substance use or abuse and risks factors as well as lay a foundation for clinical decision making (Petersen, 2016). This assignment is geared towards addressing in a comprehensive client assessment a case study of the Hernandez family who was referred for family assessment and counseling.

Demographic information

Juan and Elena Hernandez are married Hispanic couple with two children- Juan Jnr who is 8 years old and Alberto who is 6 years old. They are a working family in the low socioeconomic class.

Presenting problem

Juan and Elena Hernandez present due to concerns that they will lose their children to Child Protective Service (CPS) if they fail to attend these family sessions. They were referred for parenting/counseling sessions because of ongoing CPS involvement with their family for safety concerns with their parenting skills especially in the ways they discipline their children.

History of present illness

Juan and Elena have been ordered to attend these sessions due to investigation and possible evidence of child abuse or maltreatment in the home and this intervention is in an effort to teach the parents better skills at managing and disciplining their children instead of resorting to abusive methods.

Past psychiatric history

Record unavailable- Needs to be added

Medical history

Record unavailable- Needs to be added

Substance use history

Record unavailable- Needs to be added

Developmental history

Record unavailable but children observed to be engaged in age-appropriate play and behaviors during the visit.

Family psychiatric history

Record unavailable- Needs to be added

Psychosocial history

The relationship between Juan and Elena appears loving and healthy. Juan and Elena are hardworking people who report their priority as taking care of their family. Juan works overtime to be able to provide for the family. They expressed the strain this is putting on their finances to be able to attend the counseling sessions.

History of abuse and/or trauma

Based on the information provided after creating their family genograms, both Juan and Elena are both victims of possible harsh means of discipline while growing up. Juan described that his parents made him carry heavy books for an extended period of time as punishment for bad behavior and Elena explained that she received similar painful punishments from her parents as well.

Physical assessment

All members of the Hernandez family appear physically well, they appear well-groomed, the children appear healthy and their sizes appear appropriate for their age.

Mental status exam

Juan and Elena appear alert and oriented, they are able to understand the social worker as well as communicate to her with no problems. They have appropriate attention, affect and good eye contact.

Differential diagnosis

According to the DSM V manual, the possible differential diagnosis for the Hernandez family will be:

1.      Acculturation Difficulty (V62.4): The therapist should be conscious of acculturation when starting to formulate a case for immigrants especially in the area of enculturation (Paniagua, 2018).  In enculturation, clients tend to appreciate more of the values and behaviors from their country of origin and prefer to stick with their cultural identity and methods than adapting to a new culture (Paniagua, 2018).  The Hernandez family is having difficulties in understanding why their methods of discipline are regarded as abusive when it was appropriate in their country of origin. This confusion can lead to a conflict in their family structure as they are having a hard time mixing elements of their culture and the American culture.

2.      Victim Child Abuse, Maltreatment or Neglect (V61.21): Child abuse and maltreatment have a profound impact on children and families (Slep, Heyman & Foran, 2015).

It is difficult to define maltreatment across cultures because different cultures resort to different punishment styles as their normal parenting disciplining style (Slep, Heyman & Foran, 2015). Child maltreatment is difficult to assess as parents may not disclose such information and children depending on their age are considered unreliable reporters and also many practitioners are nervous about assessing for possible maltreatment due to fear that these questions will be misunderstood (Slep, Heyman & Foran, 2015). For the Hernandez family, the acts that led to the referral for the family counseling and CPS involvement will fall under the non-accidental verbal or symbolic acts by a child’s parent or caregiver that have reasonable potential to result in significant psychological harm to the child (APA, 2013). These acts include behaviors like reviling, threatening, confining/constraining the child, scapegoating, excessively disciplining the child through physical and non-physical means (Slep, Heyman & Foran, 2015).

Case formulation

The Hernandez family comprising of Juan, Elena, and 2 kids. Juan and Elena have been mandated to attend family counseling sessions due to recent involvement with CPS in their family that led to the questioning of their parenting skills and methods of discipline of their children. The Hernandez’ are Hispanic immigrants and they do not see any problem with their parenting style and methods of discipline. Mr. Hernandez states he loves his family and provides for them and when he disciplines his children it’s because he loves them. Even though they attend these classes, they are still filled with resentment for the system that is forcing them to take a class that they view as unnecessary and expensive for them. In the formulation of this case, it is important to be conscious of how enculturation could create a stressor for immigrants and find out what beliefs or style in their culture in terms of disciplining children is appropriate or viewed as maltreatment.

Treatment plan

An appropriate approach for the Hernandez family will be by the use of structural family therapy. The family is viewed as a functional unit and the behavior of one member affects the behaviors of the other members of the family. The therapist will focus on introducing the new ways of interacting with one another by exposing patterns and behaviors that are detrimental to the family dynamics and helping them discover and establish new routines that are healthier and promote a stable and safe experience for everyone in the family.

 

 

 

 

 

 

 

 

 

 

 

 

 

References

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

Laureate Education (Producer). (2013a). Hernandez family> Sessions 1—6 [Video file]. Author: Baltimore, MD.

Paniagua, F. A. (2014). Assessing and treating culturally diverse clients: A practical guide (4th ed.). Thousand Oaks, CA: Sage.

Paniagua, F. A. (2018). ICD-10 versus DSM-5 on cultural issues. Sage open, 8(1), 2158244018756165.

Petersen, S. W. (2016). Advanced health assessment and diagnostic reasoning. Jones & Bartlett Learning.

Slep, A. M. S., Heyman, R. E., & Foran, H. M. (2015). Child maltreatment in DSM-5 and ICD-11. Family Process, 54(1), 17–32. https://doi-org.ezp.waldenulibrary.org/10.1111/famp.12131