Hernandez Family Assessment Week 5

Review this week’s Learning Resources and reflect on the insights they provide on family assessment.
View the Hernandez Family: Sessions 1-6 videos, and consider how you might assess the family in the case study.
Note: For guidance on writing a comprehensive client assessment, refer to pages 137–142 of Wheeler (2014) in this week’s Learning Resources.
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

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amilies play a crucial role in providing children with security, as well as paying attention to their needs. However, child welfare organizations may request for family assessment if they suspect that a particular family is engaging in child abuse or children are being mistreated. During the family assessment, the therapists collaborate with children’s welfare agencies in identifying the cause of child maltreatment. Consequently, the agencies can compel the family to undergo parenting classes to learn how to discipline children appropriately, in addition to assisting the family in coping with mental health challenges. This study will focus on the family assessment of the Hernandez family, in a case study scenario where Juan and Elena are accused of using abhorrent means of punishing their children.

Hernandez Family Assessment

Demographic Information

The Hernandez family incorporates Juan, the husband, Elena, the wife, Juan Jr., and Alberto, their two sons. However, the family also incorporates Hector, Juan’s father, as well as Marie, Senta, and Rose, who are Juan’s younger sisters. Elena also indicated that she comes from a family of two brothers and three sisters, and her parents were still alive. Both Juan and Elena Hispanics. Hernandez Family Assessment Week 5

Presenting Problem

Both Juan and Elena were accused by a social worker for being cruel in the way they were disciplining their two sons. Juan’s son had informed his teacher of the kind of punishment he received, who in turn reported to the social worker about the Hernandez family. The social worker, through the Administration for Children Services (ACS), visited the family and informed the couple to join a non-voluntary parenting class, which would enable them to learn how to discipline their children without causing mental harm to them.

History of Present Illness

The couple has not admitted being sick in recent times, and each seemed to be healthy and carrying out their responsibilities effectively. The children also appeared healthy, as they are seen playing with their toys when the social worker visited their home.

Past Psychiatric History

No member of the family has a history of mental illness or ever visited a psychiatrist for the same. Additionally, the couple has not revealed whether any of them had ever tried to commit suicide or any other self-destructive behavior. However, the way the couple disciplines their children implies that they should visit a psychiatrist, who would evaluate their mental state.

Medical History

Both Juan and Elena were not under any medication and appeared healthy and well-nourished. They did not reveal whether they had been under medication or hospitalized earlier in their lives. Neither did they indicate whether they are taking birth control pills or vitamin supplements. The children also appeared healthy, and their parents did not indicate whether they were taking any medication or have a history of medications.

Substance Use History

The couple does not seem to behave abnormally and has not admitted to using drugs or taking alcoholic drinks.

Developmental History

No developmental problem was noted in the Hernandez family, as the children are seen playing independently around with their toys. For optimal child development, an active engagement of adults is necessary to teach them acceptable behavior (Sege et al., 2018). The children seemed to respond well to their parents’ instructions.

Family Psychiatric History

The couple has never visited a psychiatrist, as they assumed that they were not acting above what is perceived as normal when dealing with their children’s behaviors. Despite receiving harsh punishment from their parents, the children do not depict signs of trauma or mental problems.

Psychosocial History

Juan and Elena depicted that they are committed to making their family live a comfortable life, where Juan has been working overtime while Elena helps in undertaking home activities. The couple seemed to be in a strong relationship, as they agreed on family matters and are concerned about why they should leave their responsibilities to attend parental class. Family functioning seemed to prominently mold the psychosocial adaptation, as well as the mental health of the children (Nasir et al., 2019). The couple’s children seemed to have adopted the lifestyle that their parents have exposed them to, as they are seen playing together in the house and responded well to their parents’ instructions.

History of Abuse and/or Trauma

Both Juan and Elena admitted that they experienced harsh forms of punishment from their parents when they were young. Juan indicated that both his parents used to punish him by forcing him to hold heavy books for a time until his hands could not tolerate the weight. Elena also indicated that she had a miserable childhood due to her parent’s method of child discipline.

Review of Systems

The review of the system (ROS) is accomplished using HEENT (head, eyes, ears, nose, and throat) examination, which is the initial component of the overall physical exam after assessing the vital signs (Chen & Zeng, 2020). The couple seemed healthy and did not demonstrate any form of weakness, fatigue, fever, loss of weight, or chill. They demonstrated proper vision, good listening skills, no sneezing or sore throat. The children did not show any form of fever, sneezing, running nose, itching, chest pain, shortness of breath, headache, or bruises.

Physical Assessment

The couple appeared to be physically fit and well-groomed while their children are developing normally. There are no signs of physical harm or mishandling of children during the visit by the social worker. Children seemed to respond effectively to their parents’ demands and were playing games that corresponded with their developmental age.

Mental Status Exam

Juan and Elena do not depict cognitive impairment and are well aware of the consequences of mistreating their children. However, the couple needs to undergo a structural family therapy, where problems are identified in one of the family members in a linear perspective, and proceed to other family members through an interactional perspective (Nichols & Tafuri, 2013). The couple is ready to change for the sake of their children, and have been looking forward to joining other couples to learn the most appropriate ways of inculcating desirable behaviors in their children. Hernandez Family Assessment Week 5

Differential Diagnosis

1) Acculturation difficulty: This is a common problem among immigrants, who find it hard to fit into the culture of the host country. This problem seemed to fit the Hernandez family quite well because they are foreigners who are unable to accept the foreigners’ method of disciplining their children.

2) Poor parent-children relationship: Parents may be too strict for the children, leading to fear and trauma. However, the children did not show signs of fear or trauma when they were cautioned to stop their arguments by their father.

3) History of physical abuse as children: This situation can happen when parents were victims of child abuse when growing up, and may end up using the same method on their children. This form of diagnosis does not fit the case because the children do not show signs of physical injuries.

Case Formulation

Juan and Elena are married couples and have two sons: Juan Jr. and Alberto, 8 years and 6 years, respectively. However, the couple is under investigation from the ACS, who claimed that the two have been practicing child abuse through their strange method of disciplining their children. The couple responded by stating that they received the same form of punishment from their parents when they were kids. Consequently, Juan and Elena have been instructed to participate involuntarily in a parenting class session to learn the most appropriate methods of disciplining their children. However, the couple feared that they would lose a lot by attending the sessions. The two failed to meet the minimum number of sessions to qualify for a certificate, where the ACS worker maintained that they should complete the required number of sessions.

Treatment Plan

a) Biologic: There are no known medications for clients who engage in child abuse and mistreatment. Additionally, no laboratory tests were done because the family did not complain of any illness or injury.

b) Psychological Therapy

Hernandez’s family needs family therapy, where each member is expected to attend the therapy to learn how to cope with family issues. Cognitive-behavioral family therapy (CBFT) is an appropriate form of family therapy that focuses on treating certain disorders exhibited by individual members, instead of having a general therapy for the entire family (Dattilio & Epstein, 2016). Family therapy works through addressing the conflict between couples, as well as assisting in adopting appropriate methods of handling children’s behavior.

c) Social Support

Social support is also vital to enable Hernandez to share his experience with other families while getting support from community organizations. Social support can help in the management of family resources, where social workers offer guidance on how to cater to children’s needs.

References

Chen, G., & Zeng, R. (2020). Physical Examination of Head. In Handbook of Clinical Diagnostics (pp. 151-163). Springer, Singapore.

Dattilio, F. M., & Epstein, N. B. (2016). The cognitive-behavioral couple and family therapy. In T. L. Sexton & J. Lebow (Eds.), Handbook of family therapy (p. 89–119). Routledge/Taylor & Francis Group. Hernandez Family Assessment Week 5

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