Hernandez Family

Assignment 1: Hernandez Family Assessment

Solution

Introduction

Hernandez family presents with health patterns that are critical to the assessment of the models related to healthcare provision. This family health assessment presents an overall evaluation of the family’s health situation as the subject of the examination.

Demographic Information

Hernandez family is a conventional family comprising 27-year old  father Juan Hernandez, 25-year old mother Elena Hernandez and their two male children namely Juan Jr.(8) and Alberto(6). The family currently resides in Queens, New York. While Juan works in the airport baggage section, Elena is a babysitter for a family residing in their neighborhood. Due to financial constraints, Juan has to work overtime to bridge the family’s financial shortfalls.

Presenting complaint

Both parents referred to Administration of Child Services for the manner in which they punish their children which the social worker believes is too harsh.

History of Presenting Illness

The family was well until one of the sons Juan Jr. reported to a staff within school that his parents make him kneel and hold out his hands holding encyclopedias in each as punishment. A social worker was then called in to intervene and her assessment was that the parents’ method of punishing their two children was too harsh. This and the involvement of the Administration of Child Services mandated the parents to attend parenting classes or else have their children taken away from them. The parents however do not find their means harsh and feel the intervention is unnecessary given the fact that they too were raised in similar ways by their own parents.

Past Psychiatric History

None of the parents point towards a history of psychiatric illness amongst them or within the family although both admit to being severely punished as children. More needs to be added

Medical History

There is no history of past admissions. No history of past acute or chronic illnesses. More information is needed

History of Substance Use

The Hernandez family feels strongly and advocates against issues surrounding substance abuse. The family has no history of abusing or using substance. However, both Elena and Juan often drink socially with family and friends, with Juan sometimes going out with friends on weekends in order to blow off steam, having beers.

Developmental History

The parents indicate their children achieved their developmental milestones as expected. They too report no delays in their developmental milestones.

Family Psychiatric History

They report no psychiatric illnesses within the family. More information is needed

Psychosocial History

The marriage union of the couple is heterosexual. Finances seem to be a huge struggle for the family and Juan has got to work extra hours in order to be able to provide fully for his family. More information is needed.

History of trauma or abuse

Juan reports receiving severe punishment from his father whenever he did wrong while still young. He’d be ordered to go get encyclopedias and hold them up with both hands outstretched as punishment. He reports having the sensation that his hands would fall off. His mother administered similar punishment to him and reports it would be more severe by having to hold up more books. Elena admits to having similar severe punishments when she was still a child with Juan holding the belief, he must have got it from them. However, they both deny receiving or meting out any physical abuse.

Review of Systems

Respiratory-

No wheezing, no chest pains, no coughing, no hemoptysis, no paroxysmal nocturnal dyspnea

Cardiovascular-

No Palpitations, No Orthopnea, No Chest Pain, No Dyspnea on Exertion, No paroxysmal nocturnal dyspnea, No shortness of breath, No Claudication, No Edema,

Gastrointestinal-

No Pain, No Nausea, No Flatulence, No Diarrhea, No Melena, No Constipation, No Heartburn, No Dysphagia, No Anorexia, No Hematochezia, No Jaundice, No Vomiting

Genitourinary system –

No Hesitancy, No Dysmenorrhea, No Hematuria, No Dysuria, No Urinary Flow Changes, No Urinary Frequency, No Urinary Incontinence, No Flank Pain, No Urgency, No dysfunctional uterine bleeding.

Central nervous system-

No Paresthesia, No Weakness, No Syncope, No Numbness, No Headache, No Dizziness, No Loss of Consciousness.

Musculoskeletal system-

No Neck Pain, no positive Injury History, No Joint Swelling, No Joint Stiffness, No Arthralgia, No Myalgia, No Back Pain,.

Summary

            These are Juan and Elena Hernandez 27 and 25 year old respectively. A couple from Queens, New York who presented with complaints of allegedly administering too harsh punishments to their sons Juan Jr. (8) and Alberto (6). There exists no past history of psychiatric illness, child abuse or neglect.

Mental Status Examination

The clients are two young looking male and female clients seated looking well groomed and appropriate for age. Both are co-operative and willingly engage in conversation. Their speech is of normal rate and rhythm, coherent and audible. They exhibit an anxious mood but with appropriate affect. Both are well oriented to time place and person displaying intact short- and long-term memory. They display good abstraction with intact insight and judgement

Differential Diagnosis

Axis I – Clinical Diagnoses – Post-traumatic Stress Disorder

Axis II – Personality Disorders and mental retardation – NIL

Axis III – Any General Medical Conditions – NIL

Axis IV – Psychosocial and Environmental problems – Financial hardships

According to APA 2013, exposure of an individual to an intense or prolonged psychological stressor qualifies as being diagnosed with PTSD. The scenario above depicts a couple that have had rough and severe punishments meted out to them in their childhood. Juan at one point infers “I think I inherited it from my parents”. This alludes to the fact that he feels that perhaps his high handedness may be as a result of his childhood experiences. The fact that the family struggles to make ends meet especially financially with Juan having to work overtime  to raise enough money for his family points to an added social stressor that might also be negatively impacting on the parents and by extension the children. The abuse can arise as result of parents disciplining their children with uptight anger and stress which lead to abuse (Coleman, 2018).  

Treatment Plan

Family Group Therapy

CBT (Cognitive Behavioral Therapy)

Family Group Therapy entails a structured therapy that is tailored to minimize or decrease family conflict while galvanizing around family strengths (McLendon & Petr, 2005). This approach is essential in ensuring that a family unit minimizes on actions that may lead to strife among members and ensure that they support and coalesce around that which is god. CBT on the other hand encourages taking responsibility for actions and acknowledging there will be consequences for the same.

Conclusion

This family assessment was done on the Hernandez family and focused on various elements of assessment including the family’s demographic information, physical assessment, psychosocial issues, medical history, potential substance use, developmental history, trauma and abuse, mental health, differential diagnosis, as well as treatment planning alongside other aspects of assessment. Based on the findings of this assessment, it is clear that the family presents with health patterns that are critical to the assessment of the models linked healthcare provision.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Coleman, P. (2018). What is the Difference Between Discipline and Abuse? It’s all about what transpires in the moment. Retrieved from https://www.fatherly.com/parenting/what-is-the-difference-between-discipline-and-abuse/

Mclendon, D., Mclendon, T., & Petr, C. G. (2005). Family-Directed Structural Therapy. Journal of Marital and Family Therapy, 31(4), 327-339. doi:10.1111/j.1752-0606.2005.tb01574.x