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[ANSWERED] As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.

Assignment : Hernandez Family Assessment

Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues. As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.

Learning Objectives

Students will:

  • Assess client families presenting for psychotherapy

To prepare:

  • 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

Note: Any item you are unable to address from the video should be marked “needs to be added to” as you would in an actual comprehensive client assessment

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

Expert Answer and Explanation

Hernandez Family Assessment

Demographic information

Hernandez’s family is a Mexican family of three comprising of Mr. Juan Hernandez, Elena Mrs. Hernandez, and their two sons. Mr. Hernandez comes from a family of four, where he is the eldest child. His father is alive, but his mother died two years ago. Elena comes from a family of five.

Presenting problem

The presenting problem for his family is that the two parents are having issues disciplining their kids. They think that punishing the two boys is the best way to discipline them and ensure that they are responsible.

History or present illness

The couple did not identify any history of illness or presenting disease within the family.

Past psychiatric history

They did not report major past psychiatric history. However, Mr. Hernandez acknowledged that the punishment of carrying books changed his mentality towards books and how to discipline children. Mrs. Hernandez also agrees that her childhood was misery when it comes to punishment.

Medical history

The family has no history of major medical conditions.

Substance use history

The family has no history of substance use disorder.

Developmental history

Mr. narrated that when they were developing, they used to learn the hard way. Their parents used to punish them whether they went against the rules. When developing, there was nothing like talking to kids.

Family psychiatric history

The family has no history of psychiatric conditions.

Psychosocial history

The family has social support. According to Archer et al. (2017), people from Mexican ethnic groups value their families a lot. Both Juan and Elena have family members who can support them socially. Juan has three other sisters, while Elena has four more siblings that can support her.

History of abuse and/or trauma

Juan and Elena noted in the interview that the kind of punishment they received were harsh and hard to forget.

Review of systems

“Needs to be added to”

Physical assessment

“Needs to be added to”

Mental status exam

“Needs to be added to”

Differential diagnosis

  1. Post-Traumatic Stress Disorder (PTSD). PTSD is a mental condition associated with failure to heal after witnessing or experiencing traumatic events (Kothgassner et al., 2019). The patients looked traumatized from their past experience with their parents. Mr. Hernandez notes that books terrify him because they were used as form of punishment.
  2. Intermittent Explosive Disorder (IED). IED is the primary diagnosis for the case above. IED is mental condition where one acts out of proportion by showing recurrent, unexpected episodes of aggressive, impulsive, and violent behavior (Fanning, Coleman, Lee & Coccaro, 2019). The clients show signs of IED by preparing to use old violent ways, such as beating discipline their kids (Laureate Education, 2013a).
  3. Acute Stress Disorder (ASD). ASD is a mental condition caused by anxiety from a traumatic event (Gelernter et al., 2019). The clients underwent traumatic events with their parents in the past, and hence risk suffering ASD.

Case formulation

Case formulation, also known as clinical or problem formulation, is a theoretically-based conceptualization or explanation of data collected from clinical assessment. Case formulation can be used to hypothesize the nature and cause of the presenting problems (Gazzillo Dimaggio & Curtis, 2019). The clinical formulation is often an alternative framework to a more categorical approach to psychiatric diagnosis. The formulations are used to offer a framework for the creation of an effective and efficient treatment plan. Based on the interview in the videos herein, Mr. and Mrs. Hernandez have problems disciplining their children. They think that punishing the kids the “old fashion way” is the best way to instill discipline in children. The parents think that they are raising their kids well by providing them with basic needs. PTSD has impacted their thought of disciplining children.

Treatment plan

Through the patients feel that they are raising their kids well. They should embrace the new approaches to raising children and include them in their parenting. Therefore, the social worker should help them develop new techniques to raise 21st-century children. They should attend parenting sessions as required by ACS in the case to learn more about parenting techniques. Sege et al. (2018) report that parents can raise their children by setting limits for their children and maintain consistency with their disciple. For instance, children should not ne allowed to watch TV before doing their homework. Parents can also boost their kids’ self-esteem to make them feel proud (Ruiz et al., 2016). The authors note that parents can build self-esteem by praising children after acting good and conducting things independently.

References

Archer, N. P., Perez-Andreu, V., Stoltze, U., Scheurer, M. E., Wilkinson, A. V., Lin, T. N., … & Rabin, K. R. (2017). Family-based exome-wide association study of childhood acute lymphoblastic leukemia among Hispanics confirms role of ARID5B in susceptibility. PloS one, 12(8), e0180488. https://doi.org/10.1371/journal.pone.0180488

Fanning, J. R., Coleman, M., Lee, R., & Coccaro, E. F. (2019). Subtypes of aggression in intermittent explosive disorder. Journal of psychiatric research, 109, 164-172. https://doi.org/10.1016/j.jpsychires.2018.10.013

Gazzillo, F., Dimaggio, G., & Curtis, J. T. (2019). Case formulation and treatment planning: How to take care of relationship and symptoms together. Journal of Psychotherapy Integration. https://psycnet.apa.org/doi/10.1037/int0000185

Gelernter, J., Sun, N., Polimanti, R., Pietrzak, R., Levey, D. F., Bryois, J., … & Aslan, M. (2019). Genome-wide association study of post-traumatic stress disorder reexperiencing symptoms in> 165,000 US veterans. Nature neuroscience, 22(9), 1394-1401. https://www.nature.com/articles/s41593-019-0447-7

Kothgassner, O. D., Goreis, A., Kafka, J. X., Van Eickels, R. L., Plener, P. L., & Felnhofer, A. (2019). Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis. European journal of psychotraumatology, 10(1), 1654782. https://doi.org/10.1080/20008198.2019.1654782

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

Ruiz, J. R., Cavero-Redondo, I., Ortega, F. B., Welk, G. J., Andersen, L. B., & Martinez-Vizcaino, V. (2016). Cardiorespiratory fitness cut points to avoid cardiovascular disease risk in children and adolescents; what level of fitness should raise a red flag? A systematic review and meta-analysis. British journal of sports medicine, 50(23), 1451-1458. https://bjsm.bmj.com/content/50/23/1451.short

Sege, R. D., Siegel, B. S., Abuse, C. O. C., & Committee On Psychosocial Aspects Of Child And Family Health. (2018). Effective discipline to raise healthy children. Pediatrics, 142(6). https://pediatrics.aappublications.org/content/142/6/e20183112

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