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​Comprehensive Client Family Assessment Demographic information: Latino American family. Low socioeconomic status, working class. Presenting problem: “Social worker believes our discipline style is too harsh and we need

parenting classes”

History of Present Illness: Both clients present to the office with concerns regarding their

children being “taken away” by social services as she believes they parent too harshly. They

adamantly proclaim that they are very good, loving parents but believe that when a child is not

following the rules, strict and physical discipline is necessary. They both explain that they were

brought up this way and that physical or emotional abuse is not present. They explain that this is

part of their culture and all they know is right. The social worker referred to the family as “those

Mexicans” and seemed to be bias towards the family. Also, she seemed to not consider any

alternative for the family after they requested it based on their working schedule and after

explaining their cultural belief system.

Past Psychiatric History: “Needs to be added to”

Medical History: “Needs to be added to”

Substance Abuse History: No indication for substance abuse. “Needs to be added to”

Developmental history: Parents report that their two sons all have met their milestones

throughout their development and are ages 6 and 8 years old. “Needs to be added to”

Family psychiatric history: “Needs to be added to”.

Psychosocial history: Male client works full-time and overtime to provide for the family. “Needs

to be added to”.

History of abuse/trauma: Based on the genogram created, both clients father and mother have a

history of disciplining their children similarly. They both would require the clients to hold

encyclopedias out in front of them until their arms “felt like they were going to fall off”. Both

clients report this type of discipline as being miserable and that they inherited this from their

parents. No physical or mental abuse of concern.

Review of Systems:

HEENT:​ No loss of vision or hearing. No sign of congestion, sore throat, or runny nose. SKIN:​ Cool and dry skin with no signs of wounds or lesions. CARDIOVASCULAR:​ No complaints of chest pain, tightness, discomfort or palpitations. S1, S2 heard upon auscultation. 2+ pedal and radial pulses. No weight gain and no edema. RESPIRATORY:​ Clear lung sounds with no adventitious sounds. No rhonchi or wheezes auscultated, and chest is symmetrical. No cough present. GASTROINTESTINAL:​ No nausea, emesis, or diarrhea. Abdomen soft, no distention, no discomfort on palpation. Bowel sounds present in all four quadrants. GENITOURINARY:​ No burning or discomfort when urinating. NEUROLOGICAL:​ No double vision, headaches, seizures. No loss of memory. Alert and oriented x person, place and time. Agitation present in male client. MUSCULOSKELETAL:​ No joint or muscles pain. No generalized weakness. HEMATOLOGIC:​ No signs of bleed, no history of anemia. No dizziness or lightheadedness upon standing.

LYMPHATICS:​ Lymph nodes normal in size on palpation. No history of splenectomy. PSYCHIATRIC:​ “Needs to be added to” ENDOCRINOLOGIC:​ No history of diabetes. Fatigue noted. No heat or cold intolerance. No brittleness of skin and hair noted.

Physical Assessment: Vital signs: BP: 145/89, Pulse: 104, Resp: 22, Temp: 97.9, Oxygen Saturation 92% on RA, Neck: Negative jugular vein distension. Chest/Lungs: Clear and with no crackles, rhonchi or wheezing. Thorax symmetrical. Heart/Peripheral Vascular: S1, S2, and S3 heart with no murmur present, pulses+2 bilateral pedal and +2 radial pulses. ABD: Abdomen soft and nondistended, regular bowel sounds heard in all 4 quads. Skin/Lymph Nodes: No edema in bilateral extremities, no clubbing, or cyanosis; no palpable nodes, cool and dry skin. · ​Mental status exam: Both clients alert and oriented to person, place and time. Hygiene and

apparel appropriate. Both clients conduct good eye contact and participate in conversation. Male

client seems to be agitated at times regarding having to take parenting classes while the female

client is more accepting. Attention is intact and both speak clearly and offer information freely.

No paranoia, hallucinations or delusional activity noted. Both clients willing to participate with

interventions to complete the parenting classes.

Differential Diagnosis

The main focus with these parents is deciding whether or not their discipline is

considered appropriate or abusive. As discipline is the system of teaching a child what is good

and bad, punishment and appraisal is consistent with the processes of this teaching (Discipline,

parenting styles and abuse, 2017). One key way to distinguish punishment vs abuse is by

examining if the parent has anger that plays a role in the administration of punishment

(Discipline, parenting styles and abuse, 2017). In the case of the Hernandez family, culture plays

a role in their beliefs for punishment and their expectations of their children. Typically, if the

punishment is not in an extreme, nor anger used, then the punishment would not be considered

abusive. Although, clients of different backgrounds and belief systems are encouraged to accept

dominant cultures around them and be open minded. Based on this families cultural belief

system and practices, the fact there is no sign of physical abuse on the children, nor complaints

of neglect or emotional abuse I would advise the parents that there parenting style isn’t

considered abusive but being open minded regarding other techniques is always helpful

(Coleman, et al., 2010).

Individualized Treatment Plan

Conducting a cultural formulation interview (CFI) is one of the most important aspects of

a mental health assessment. Assessing the client's values, practices, background, influence of

family, cultural identity, and their conceptualization of distress all lead to the framework needed

to personalize a treatment plan that is tailored to a certain family, according to the DSM, (2013).

Structural family therapy and group therapy are chosen to assist the family in exploring their

parenting styles by offering a framework to address problems in the home. By utilizing the

structural family therapy approach, power structures, imperceptible rules, communication

patterns and boundaries are able to be assessed which can lead to an increased obedience of the

children and decreased need for punishment, according to Wheeler, (2014). The main goal of

therapy for this family would be to create an effective structure with clear boundaries, open

communication, direct, clear rules where roles are flexible (Wheeler, 2014).

References

American Psychiatric Association. (2013). ​Diagnostic and statistical manual of mental

disorders​ (5th ed.). Washington, DC: Author.

Coleman, D. L., Dodge, K. A., & Campbell, S. K. (2010). WHERE AND HOW TO DRAW THE LINE

BETWEEN REASONABLE CORPORAL PUNISHMENT AND ABUSE. ​Law and Contemporary

Problems​, ​73​(2), 107–166.

Discipline, parenting styles and abuse. (2017). Pa Family Support Alliance: Protecting Children

from Abuse. Retrieved from

http://www.pa-fsa.org/Parents-Caregivers/Preventing-Child-Abuse-Neglect/Discipline-Pa

renting-Styles-and-Abuse

Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Theory. Retrieved

from http://www.nursing-theory.org/theories-and-models/erickson-modeling-and-

role-modeling-theory.php

Wheeler, K. (Ed.). (2014). ​Psychotherapy for the advanced practice psychiatric nurse: A how-to

guide for evidence-based practice​ (2nd ed.). New York, NY: Springer Publishing

Company.

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