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					                                    University at Buffalo
                              The State University of New York
                                     School of Nursing
James Cozza
NUR 310 - Spring 2007

            ASSESSMENT OF A FAMILY'S LEVEL OF ADAPTATION

A.     THE FAMILY

       Armand Smith (“Father”) – 56 y/o, DOB 08-15-50 in Brooklyn, NY (lives with Nancy)
       Barbara Smith (“Mother”) – 54 y/o, DOB 08-25-52 in Buffalo, NY (lives with Ronald)
       Caroline Smith (“Daughter”) – 32 y/o, DOB 01-10-75 in Buffalo, NY (single mother of two)
       Donna Smith (“Daughter”) – 27 y/o, DOB 03-21-79 in Buffalo, NY (married with one child)
       Edward Smith (“Son”) – 26 y/o, DOB 06-11-80 in Buffalo, NY (single)

B.     GENOGRAM (Show data regarding a minimum of 3 generations of this family. Include
       the age, sex, and a comment on the health of each person. If a person is deceased,
       include date and cause of death.)
C.      1ST LEVEL ASSESSMENT

        **[Information was found via direct (or indirect) question, direct observation, or
        previous familiar contact with the family. Direct (or indirect) Question will be
        referred to as “DQ”. Direct Observation will be referred to as “DO”. Previous
        Familiar Contact will be referred to as “FC”. Additional commentary and reasoning
        will be inserted when needed]

I.      Role Function
        A.       Family Organization
                 1.       Type
FC – Blended Family, the Smiths youngest children are the biological children of the parents.
The eldest child is the biological child of the mother and a deceased father from a previous
marriage. The eldest child’s name was changed from Doe to Smith after the marriage of Armand
and Barbara.
                 2.       Open or Closed system
DQ – Open system, the Smiths accepted an invitation for a family assessment study with
questions.

                  3.      Developmental Phase of Family
FC – Middle Aged Family, per Dr. Fiegenbaum’s approval. The Smith’s are a middle aged family
because all children have left the home and they are all independents. The eldest child is 32y/o.
The two Smith daughters have families of their own with children and the son is single. The
children rely on their parents for emotional, social support but not for financial support.

                  4.      Role Models
                  Who are your role models? Why? Who are the parents’ role models for
                  parenting?
DQ – Father and mother’s role model is their next store neighbor, Mr. Garrison. Mr. Garrison has
been a longtime friend and neighbor for over 25 years. He is currently 75y/o and he is viewed as
a father figure to both parents. Interestingly enough, both parents view Mr. Garrison as a role
model for parenting too. The parents do not view their own parents as role models for their
parenting. The son views the father as a role model, along with Donna’s husband. Donna and
Caroline view their mother as a role model for parenting and life. The mother also stated that her
late husband looked up to Armand for parenting.

        B.        Role Allocation (Division of Labor)
                  1.      Formal versus Informal
                  What are certain things must the father do? Mother? Sister? Brother? Etc…
DQ & DO – The general consensus is that there are very few formal roles. The whole family
believes that all members are responsible for all activities and tasks. During the school age and
adolescent times, there was a stronger role of the parent and child. The parents believe that
parents should be parents and NOT friends for their children. The mother especially believes in a
strong parenting role during childhood. Donna seems like the mediator. Edward is the joker and
commanding humorist. Barbara plays the role of the social secretary.

                  2.       Implicit versus Explicit
                  What are the rules of the house?
DQ – During childhood ages, there was curfew and many rules for Donna and Edward. Rules
were explicitly set in place for Donna in particular. She tended to be the trouble maker. Caroline
was viewed as a “good kid”. There were no rules needed for Caroline because she was a quiet
kid who always stayed out of trouble. Donna and Edward could not watch tv before homework,
had to do there chores that were displayed on homemade charts. Donna and Edward hated the
act of calling parents before any sleepovers or any activities.

                3.      Clear versus Confused
DO – There does not seem to be any role confusion. Information inferred due to limited
information from family.

               4.      Appropriate versus Inappropriate
DQ – Parents agree that parents should be parents and not friends. Parents need to parent.

               5.       Sex Defined
DQ – The family believes that there are no sex defined roles except garbage and dog pooper
scooping are usually done by the men.

                6.       Flexible or Inflexible
DQ – The Smith family agrees that most roles are flexible. Armand always enjoyed cooking with
his own father. Edward cooks with Armand regularly and when he was a child. Edward
continues to cook for a profession. Armand believes cooking and cleaning should be shared
tasks.

                7.      Instrumental versus Expressive
                What is your family role?
DQ & FC – Armando, the father, states he plays the role of emotional support and odd jobs
support for Caroline and Donna. Armand also believes he is available for financial support for his
children. Barbara states she plays the role of the mother. She also believes she plays the role of
a counselor to Caroline and Edward at times. Caroline needs help dealing with an adulterous
divorce. Edward needs help with a difficult break up with an abusive girlfriend. Caroline and
Donna have roles of sister, daughter, wife/ex-wife, and mother. Edward has role of son and
brother.

                8.     Clear versus Breached Generational Boundaries
DO & FC – Family members tend to stay in their clear generational boundaries. Although
Caroline makes various comments and has performed various actions to suggest a motherly type
role to Donna and Edward. Caroline’s early maturity may add to her motherly instincts to her
younger siblings.

               9.      Role Reciprocity (Quid pro quo)
DO & FC & Inference – Family members switch and change roles often. The balance of roles
and mutual help with most all tasks is apparent.

                  10.     Cultural Implications
                  How does religion and culture influence your family roles? Irish culture
                  influence?
DQ - Sunday school was a large part of our children’s lives and the family attended Sunday
church every week during school age. Armand still regularly attends Church every week. Donna
and her husband attend Church every week with their son. No other family members regularly
attend Mass. The family gathers and attends mass for Christmas and Easter. The family
believes that religious values have carried over to their lives. Edward feels he should go to
church.
The family is of German, Irish, and English decent but the parents consider themselves
Americans. The parents never knew their grandparents on either side of their families except
Armand knew his grandfather on his mother’s side. He helped his mother care for his grandfather
before death. None of the grandparents of the parents played significant roles in the parents’
lives. Generally, the family believes that culture plays a little role in their lives. Donna and
Edward are proud to be part Irish.


        C.    Role Adaptation
              1.     Sense of Obligation (Role Distancing)
DQ – Armand focused and controlled the answer to this question. He feels that he is dedicated to
his family’s well being. He feels that he should always be available to support his family
financially and emotionally. He feels proud to be a father. He feels responsible for his family.

                  2.       Role Adequacy/Inadequacy (Failure)
DO & FC – The family seems generally complacent in their roles. The parents both believe that
they did a fine job with their children. Caroline feels inadequate at times and feels that she could
use some help at times with her children. Caroline feels that the family does help her out
emotionally.

               3.      Role Conflict/Strain
DQ – The family does not believe that any of them have role conflicts.

              4.      Role Consonance
DO & FC – Members maintain strong formal roles like father, mother, daughter, and son. Family
members also show flexibility in hectic situations.

                 5.      Socialization Functions (Childrearing Practices)
                 Who did the disciplining in your family? How? Who taught about sex, death,
                 other sensitive topics?
DQ – Parents believe that there was mutual disciplining. Donna and Edward believe that their
mother was less strict than their father. Donna and Edward were grounded for disciplining. The
parents also took away privileges like car use and going out with friends. Barbara’s mother died
when Donna and Edward were young (under 10y/o, per mother). Children state grandmother’s
death was first experience with death. Mother talked to children about death during her mother’s
dying process. Parents and children state that there was no formal talk about sex education.
Parents state that any questions would be answered but they believed that school would teach
their children what they needed to know. Children would go to mother for most sensitive topics,
per Edward.

II.      Interdependence
         A.       Communication Patterns
                  1.     Verbal
DO – The Smiths tend to intermittently speak louder than necessary during conversation. The
conversations tend to increase in volume. The mother tends to dominate conversation and will
talk over other family members to control a conversation. The father will make loud outbursts at
times to make a point. The children will tactfully add comments during lulls in conversation.

               2.      Kinesic
DO & FC – The family shows a high energy level that can be confrontational at times. Caroline
does not show as high of an energy level compared to the rest of the family.

               3.       Proxemics
DO – The Smiths follow traditional Western European proxemics allowing ample personal space.
The Smiths are not noticeably close or far from one another during communication.

                3.      Themes
                What are some popular topics of conversation in the family?
DO – New vacations, past Florida vacations, other past trips, and when the kids were little are the
most popular topics of conversation. Parents state their children memorize movie phrases and
dialogue and repeat them for fun. Children and parents talk about certain tv shows too, like
Friends. Parents talk about their kids and their grandkids too. Traditions, like Christmas eggs
benedict in morning, are talked about frequently.

                4.        Rules
DQ – As previously stated, the parents stated rules were more common when their offspring were
children. Similar rules that were used with Donna and Edward are beginning to appear with
Caroline’s and Donna’s children. Overall the family does retain values and rules of the Catholic
Church.

                6.       Dyads
                Where there any groups or alliances within the family? What makes the alliance
                and who are they?
DQ - The whole family agrees that Donna and Edward ganged up together versus Caroline. The
parents also function as a dyad during disciplining.

                7.       Triangles
DO – I view the children acting as a triad at times. They leave the parents out of conversation
sometimes.

                 8.      Cyclical Sequencing
DO - I do not view pure cyclical sequencing with the Smiths. I do view conversation domination
by Barbara and Donna at times. Armand looks for confirmation after certain statements during
conversation.

                9.        Specific Types of Patterns
                          a.      pseudomutuality
DO – I can infer that the Smiths do try to maintain a façade of happiness. I do believe the family
is happy but there are serious situations that are not always expressed. The family masks
Caroline’s and Edward’s problems at times. The family is reluctant to talk about their matters, but
will.

                        b.      pseudohostility
                        How do you usually handle arguments?
DO – The Smith’s are not fight phobic. They will express themselves and verbally argue when
necessary.
                        c.      schism
DO – Barbara talks over other members of the family at times. Most of the time there is little
undercutting of each other.

                        d.    skew
DO & FC – Barbara takes on some roles of the father acting as a counselor to Caroline and
Edward. Edward may be missing out on paternal view points during common maternal
therapeutic conversations. Edward’s residual needs for mental assistance are shifted to Donna’s
husband. Edward views Donna’s husband as a big brother.

                          e.      paradox
DQ & DO & FC – Edward’s individual problem with his girlfriend affects the whole family. The
family is affected by Edward’s depression due to the issue. Edward’s issue is a paradox. He
loves his girlfriend and can not be with out her. He should not be with her because she is abusive
and manipulative per Barbara.

                        f.        double bind
DO – I did not view any conflicting messages between family members or any signs of neglect.
Most communication is clear.

                  10.    Cultural Implications
DQ & DO & FC– Parents believe that culture is not apparent in their lives. Edward identifies with
his Irish heritage. The Smiths are a passionate family with their culture’s religion in their lives.
Edward and Armand also share a classic taste for beer that can be excessive at times.

        B.      Mutual Nurturance, Closeness and Identification
                1.     Nature and Extent of Bonding
DO & DQ – The family believes that they see and talk to each other but a lot less than in years
past. Armand states the family bonds during Christmas and during the summer when family
comes over to swim in the pool.

                 2.       Commitment versus Detachment
DQ – Edward moved to Florida last year then moved back. The parents felt uneasy about
Edward moving that far. Donna also moved to a town in New York with her husband but the
parents were not as concerned about that move. Overall the parents are happy about their found
freedom. They enjoy traveling with Barbara’s sister and brother in law.
Caroline feels that she is still dealing with depression and loss post adultery and infidelity from
former husband. Caroline states she is receiving help via therapy, medication and family help.
Offered information about Caroline was limited.

                  3.      Sense of Harmony
DO & FC – I have known the Smiths for 15 years. They are a kind family with typical internal
family conflicts from time to time. They have always put family first. They share love and
emotions openly creating a sense of harmony. There is no apparent abuse or neglect in the
family. They seem to coexist harmoniously with superficial bouts of argument.

                4.     Degree of Cohesion
DO & FC – The family shows a positive degree of cohesion. The family shares the same sense
of humor. There are no outsiders or rejected family members. All members of the family are
allowed to speak and voice an opinion.

                 4.      Sense of Veritivity
                 What is a common goal or value that everyone shares?
DQ & DO & FC - A common goal of the family is more trips and family vacation. The family
wishes to stay together during holidays and keep traditions like Christmas at parents home. I
sense an ideal to keep open with each and stay in contact with each other no matter where
people move. The family shares the goal to be happy and healthy, per Armand.


        C.     Separateness versus Connectedness
               1.        Individuation versus Enmeshment
DO & FC – Donna and Edward seem to be the strongest ideal individuals. They reacted on their
own accords during childhood. Caroline and the parents are immediate family oriented. They
seem to normally act for the good of the family. The family seems to share the same sense of
humor which connects them together in many situations.

               2.    Mutuality versus Isolation
               What would isolate someone from the family?
DQ – No family members offered a situation where someone would be isolated from the family.

                   3.     Degree of Differentiation (Balance of Intellectual and Emotional Systems)
DO – Barbara and Caroline are on the higher level of intellectual and knowledge. This may
attribute to their secondary educations. Donna is on the middle level of intellect and knowledge.
Armand and Edward are on the lower level intellect and knowledge. All family members are
intelligent with medium/high to high intellect and knowledge. The level scale is relative to each
other. All family members have high awareness and expression value with emotions. All family
members communicate and express emotions openly with each other in a similar way. Caroline
may be the only member of the family that is slightly closed emotionally but she seems to be able
to express herself effectively.

                4.        Flexibility versus Rigidity
DO – There is a lot of flexibility in all family members. Armand is the least flexible individual. He
has shown that there are specific topics and comments that he will not compromise on. Edward
has also has shown this rigidity during various conversations.

        D.        Social Patterns
                  1.       Alliances (Coalitions)
DQ & DO - The whole family agrees that Donna and Edward ganged up together versus Caroline.
The parents also function as a dyad during disciplining. The children also have a mutual coalition
together.
                  2.       Recreation
                  What do you do as a family? For fun?
DQ – The family enjoys on going on vacations together. The family agrees that it is more difficult
to go on family vacations due the constant growth of the family through the years. Swimming is a
big part of the family’s summer time recreation too. Armand states the family tries to get together
every so often for brunch too. The mood at the last brunch was dampened by Edward’s sour
mood, per Armand.

                3.      Autonomy
DO & DQ – Donna is viewed as the most autonomous member of the family. Caroline may be
viewed as the least autonomous. All members view themselves as autonomous in their own way.

                4.       Intimacy
DQ – Intimacy is a topic that the parents and Caroline did not feel like discussing. Edward and
Donna would talk about it but it felt a little awkward.

                 5.      Loyalty to Family
DQ & FC – The Smiths are loyal to each other. This loyalty was tested during the recent divorce
of Caroline and Calvin (Caroline’s children’s father). The family was loyal to Caroline and sided
with her emotions. Calvin had an affair with another woman. The family expressed that they are
emotionally there for Caroline and her children after the Calvin’s infidelity. The family will
continue to help Caroline cope and remain loyal to each other.

                   6.       Contacts with Significant Others not Currently Living with Family
DQ & FC – Caroline has little to no contact with her ex-husband. The two had a very difficult
divorce with the husband committing adultery. The situation was a shock to the family and it is a
very difficult topic to discuss. The family did not want to discuss the situation in detail and the
issue was not pushed. This is a significant issue in the family that may not be receiving the
attention it deserves.
Edward also has an abusive girlfriend that lives with him intermittently. His girlfriend is a constant
topic of argument and conversation for the family. Edward also sees a therapist for his
relationship with his girlfriend. The family does not like the girlfriend. Edward is having trouble
letting go of this turbulent relationship.

                 7.       Contacts with Extended Family Members
                 How would you describe current relations with grandparents? Aunts? Uncles?
                 Cousins? Etc…
DQ – The parents stay in contact with Barbara’s sister and brother in law. The rest of the family
admits to not staying in constant contact with any other of the family members on a regular basis.


        E.       Power Structure
                 1.       Decision Making Processes
DQ – Parents agree that they confer to together before big decisions. Armand and Barbara state
that either one or the other will lead the decision in certain situations.

               2.      Sources of Power and Authority
               Who’s in charge? Why?
DQ – Parents agree that they are equally in charge. Children agree that Barbara is in charge
most of the time. The children say that Barbara can be more convincing to Armand to change his
mind. Donna also has strong family power during arguments. Donna usually acts as the mediator
during family arguments between other family members. Caroline and Edward seem to have little
family power

                 3.      Variables Affecting Family Power
DQ – Topics at issue and timing are variables affecting family power per Barbara. She states she
handles certain topics and Armand handles certain topics.

                 3.      Family Power Continuum
                 How is power divided? Who holds the least power? Why?
DO & Inference – Barbara seems to be at the top of the family continuum with Armand next in
line. Donna is third due to her mediation family power. Caroline is fourth due her age and
maturity. Edward holds the least family power.

                 5.      Means of Ensuring Conformity to Rules
DO – Rule conformity does not apply to this middle aged family. The members are independent
and follow their own rules.

        F.      Family-Need Response Patterns
                1.     Affect
DO – Caroline and Edward appear with blunted affect at times. Their affect is apparent over the
phone too. Their depression seems less controlled than Barbara’s depression. Donna and
Armand appear normal with normal affect. Most of the time, all members of the family appear
with normal affect.

                 2.      Level of Anxiety (Mild, Moderate, Severe, Panic)
DO – The Smith family is in a moderate level of anxiety. Caroline’s divorce, Edward’s abusive
relationship, and Barbara’s recent trip to the ED for angina combine to create moderate anxiety
for the family. The family is still effectively solving problems together. There is also a positive
focus to handle problems concerning the family.

                4.          Family Coping Patterns
                How do you cope with a problem together?
DO & Inference– The Smith’s use pulling together and humor to solve their problems. They pull
together during difficult times instead of separating. The family’s methods of coping may not be
effective enough during the current tumultuous time.

                4.        Degree of Empathy
DO – I do not sense a strong degree of empathy for other family members. All family members
seem to have difficulty in viewing the other’s viewpoints. Family members definitely care for each
other.

               5.     Means of Expressing Anger
               How do you express anger?
DQ – Barbara, Donna, and Edward say they express anger verbally and not usually holding it in.
Armand and Caroline tend to express anger by silence. The answer was not elaborated on by
family.

                6.      Means of Controlling Aggression/Conflict
DQ – Barbara takes deep breaths. Edward states that he has trouble controlling his anger.
Limited information was given for this section.

                  7.       Means of Maintaining Morale
DQ & FC – The family enjoys taking vacations to increase morale. Caroline and Barbara state
that it is always good to talk things out with each other.
                 8.      Adaptation to Change/Enduring Chaos
                 How do you adapt to the change that Kristen is enduring? Describe how you
                 cope?
DQ & DO – The parents agree that Caroline is doing a fine job with the children. Donna and
Edward are minimally involved with Caroline’s new change due to geographical distancing. The
family seems to have difficulty adapting to Caroline’s present situation. The parents want to help
but are not sure exactly what to do.

                  9.      Level of Hardiness
DO – The family exhibits a high level of hardiness during Caroline’s current divorce situation. The
family is “sticking together” through adversity. The family seems strong under the current
hardships of divorce with young children involved.

              10.     Resiliency
DO & DQ – The family seems resilient through Caroline’s divorce and the recent death of
Armand’s mother too. The openness of emotion helps the family cope with loss.

        G.      Dissemination of Information
                1.       Sources
DO – Barbara and Armand are the center of information for the family. Being middle aged
parents, they are in contact with the entire family. The parents exhibit many roles that
necessitate communication with children, grandchildren, brothers, sisters through many
generations.

                 2.    Patterns of Communicating
DO – Barbara usually keeps the family informed about information. The information is cycled
down to Donna last because she lives the furthest away. Edward believes he is the last to hear
about family things.

               3.       Family Secrets
               What are some family myths, stories that are unique to your family?
DQ – The family can’t recall (or will not expose) any family secrets.

                 4.        Family Myths
DQ – Edward states that there has always been thought that Caroline’s biological father was a
secret agent like James Bond. In reality, Caroline’s father was a special agent for the CIA but
there is question whether or not he was a James Bond type figure or an administrative agent.
Barbara, Donna, and Edward believe that Barbara’s mother controls the street lights. They feel
that every time a street light goes out or quickly turns on is Barbara’s mothers work.

               4.      Family Rituals
               What are things you do all the time with each other?
DQ – The family does swim together during the summer. The family always has eggs benedict
on Christmas too. The family goes to church every Easter and Christmas with each other a local
Church.


        H.       Family Situational Supports
DQ – Barbara counsels her children with most emotional, social, and family issues. Armand is
sought after by the children for technical and financial support.


III.    Self-Concept
        A.     Family’s World View
                       What is your view of your family in comparison with other families?
                 1.      People
DQ – Armand and Barbara were concerned that their family was going to be scrutinized during
the interview. I assured the family that they were chosen because I know them and felt they
would accept my invitation to participate. They feel that they are a normal family overall.

              2.       Community
DQ – Armand is proud the community he lives in. He states that it is safe and clean.

                3.     Education/Schools
DQ – Barbara and Armand are both proud of the school district. They said that it was a factor in
determining the purchase of their home.

              4.      World
DQ – Armand spoke for the family. He said that his family is very lucky to live in their situation.

               5.       Religion/Spiritual practices
DQ – Armand is the only regularly practicing Catholic. He attends mass every week. Barbara
goes to mass with Armand sometimes. Barbara’s work interferes with church. Donna also
attends mass with her family. Edward feels more spiritual than religious.

                 5.      Faith
                 How would you describe the role faith plays in your lives?
DQ – Faith plays a large part in all family members’ lives. The family seems more spiritual and in
touch with their emotions then they may think.

             7.      Hope
DQ – Armand has hope that their family will work out their problems and issues with the current
situations.

                 8.      Time
DQ – Armand understands that they live in turbulent times with the war in Iraq. Barbara hopes
the world’s problems will resolve soon.

              9.      Space
DQ – Armand spoke for the family. He said that his family is very lucky to live in their situation.


        B.       Family Definitions
                          How would you define?
                 1.       Family
DO – Armand sees family as a group of people that love and help each other. Barbara adds that
family is always there for each other.

                2.     Health
DO – Health is seen as primarily physical to the Smiths. The Smiths offer little mention of mental
health.

                 3.     Illness
DO – Illness is viewed as a medical problem that should be treated.

                4.     Sources of Health Care/Support
DQ – Barbara said she had a lot of emotional support from Armand during her stay in the
hospital. Barbara and Edward state that their mental therapist (same person) is essential to their
mental well being.
        C.        Family Values as Shown by World Views and Definitions
                  1.      Conscious versus Unconscious
DO – The family is conscious of their surroundings. The family did not mention anything about
the state of the environment.

                 2.    Conflicts
DO – The family agreed on world views during the interview. There may be differences in views
outside the interview.

VI.    Physiological Adaptation
       A.       Provision of Shelter (Home and neighborhood)
DO – All family members seem satisfied with their homes and neighborhoods. The family
members all live in well to do neighborhoods with safe histories.

        B.       Levels of Energy
DQ – Armand and Barbara said that they get more sleep now that Edward is out of the house.
They feel that they have a good amount of energy for the day. Donna has lower energy due to
the toddler. Edward and Caroline have lower energy that may have to do with there emotional
and social issues.

         C.      Dietary Practices
DQ & FC – No family members typically eat 3 meals a day. Donna notices more routine in meals
with her son. The family does not eat together often due to geographical distances. The parents
and Edward have meals every few weeks at the parent’s home. Edward and Armand both cook
nutritious meals for the family get-togethers. Edward feels he does not eat as well as he should.
Caroline fixes daily meals for her children.

       D.        Sleeping and Resting Practices
       Sleep?
DQ & FC - Armand and Barbara said that they get more sleep now that Edward is out of the
house. All of the children believe that they could use more sleep. Donna is glad her son is on a
more consistent sleeping schedule now.

        E.     Exercise
DQ – Armand rides his bike in the summer. No family members admit to regularly exercising. No
family member belongs to a gym or runs.

       F.       Recreation
DQ & FC – The parents regularly go on vacations. Donna and her husband take walks with their
son. The family enjoys relaxing on days off.

        G.        Alcohol, Tobacco, and Other Drug Use (over the counter, prescription, illicit
                                   substances)
                  What are the family’s thoughts on recreational drug use?
                  Alcohol consumption?
                  Smoking?
                  Over the counter?
                  (typical use, abuse, experimenting)
DQ & FC – Armand, Barbara, and Caroline do not admit to ever experimenting with any
recreational drugs. Donna and Edward admit to trying marijuana but nothing else. Edward
showed an unconvincing smirk. All family members drink alcohol. Edward and Armand admit to
drinking alcohol almost everyday. They both prefer beer. All family members have binged drank
in the past. All family members have smoked cigarettes in the past. No family members admit to
smoking cigarettes anymore. Donna and Edward smoked during high school. Caroline and
Barbara take Advil every so often. Caroline, Barbara, and Edward are prescribed medication for
depression. Barbara takes a newly prescribed medication for high blood pressure.
        H.        Health Care Practices
                  1.      Family's Role
DQ – Parents state that their children had health care coverage, shots, and check ups up until
around age 21. After 21 y/o the kids had to get their own coverage. They do not do anything
specific for health care as a family anymore.

               2.      Health Care
               How do you take care of yourselves? Annual check ups?
DQ – The family does value health care but state that it is too expensive to cover their children
anymore. They view their children as independents and responsible for their own health care.

                  3.      Emergency Care
DQ - Barbara also had a recent acute episode of chest pain during work. She was transported to
the ED for treatment and was admitted to a telemetry unit for 3 days. She was discharged with a
clean bill of health and was prescribed medication to stabilize her blood pressure. Donna also
was admitted to the hospital for the birth of her first child.

                 4 Preventive Care
                 What do you do to prevent illness?
DQ & FC – Armand rides his bike frequently in the summer. All family members swim frequently
during the summer. Both parents visit their doctors annually. Caroline and Donna visit their
OB/GYNs annually along with pediatricians for their children. Edward does not see a doctor or
dentist annually.

                  5.      Care for Diagnosed Illnesses (Note both acute and chronic illnesses)
DQ – Barbara has diagnosed depression and high blood pressure that is being treated by her
PCP. Barbara also had a recent acute episode of chest pain during work. She was transported
to the ED for treatment and was admitted to a telemetry unit for 3 days. She was discharged with
a clean bill of health and was prescribed medication to stabilize her blood pressure. Caroline and
Edward have also been diagnosed with depression. They are both being treated by a
psychologist. Armand and Donna are healthy.

                 6.       Dental Care
DQ – Edward is the only family member without dental. He would like dental coverage but does
not have a job that will pay for it. The rest of the family tries to get annual check ups.

                  7.       Health Insurance
                  Is everyone covered? How do you feel about your own health insurance?
DQ – Everyone in the family has health insurance except Edward. Edward does not have a job
that will pay for health insurance, where everyone else does. This is concerning to the family but
everyone views Edward as an independent that is capable of receiving health insurance if he had
a different job. All family members believe that their health insurance is not adequate. The
mother states her plan makes it very difficult to receive some medications. The rest of the family
states that they simply use the health insurance for annual check ups and visits with their
children.

        I.     Environmental Practices (Cleanliness and Sanitation)
DO – The Smith’s home is clean and well taken care of. All members are clean in appearance
and pleasant smelling. The driveway is shoveled. The kitchen and bathrooms are very clean.
The Smiths show a high level of cleanliness.

        J.      Sex Education
        How was sex education handled during childhood?
DQ - Parents and children state that there was no formal talk about sex education. Parents state
that any questions would be answered but they believed that school would teach their children
what they needed to know.

         K.       Modes of Transportation
DQ – Every member of the family owns and uses an automobile. The father also uses a bicycle
for local travel during “nice weather”. The family also uses air travel for vacations.

        L.       Socioeconomic Implications
DO – Armand has done a fine job providing for his family. Barbara has also done a good job in
providing financially for her family. Like all families, they probably wish that they had more
money. The issue was not addressed completely due to time constraints.

        M.      Family's Level of Satisfaction with Home and Neighborhood
        Are you satisfied with your home, neighborhood, life?
DQ – The family is satisfied with their home and neighborhood. The parents believe it was a
good place to raise children. Armand is proud of their pool and front porch. Edward states it was
nice growing up here because of the easy access to the city. The parents are considering
moving to warmer climates due to the area’s harsh winters. Other than the weather the whole
family seems satisfied with the neighborhood.

        N.      History of Geographic Mobility
DQ – The family began in a suburb of Buffalo, NY and is currently in the same house in the
suburb of Buffalo, NY. The family has never moved homes. The parents live in the Buffalo
home. Edward lives 25 minutes from his parents in a rented apartment. Donna, her husband
and son live 3 hours from her parent’s home. Caroline and her children live 20 minutes from her
parent’s home.

D.      ECOMAP
E.        List and Describe Strengths of Family
1.   Love
2.   Openness of emotions
3.   Financially sound
4.   Proper heath care coverage
5.   Strong family loyalty
6.   Generally healthy family members
7.   Common sense of veritivity in maintaining health and happiness


F.      SECOND LEVEL ASSESSMENT
        I.        Actual or Potential Health Problem
Potential for ineffective family coping related to depression

         II.      Focal Stimulus (or stimuli) (Major factor directly influencing the actual or potential
health problem)
Ineffective interpersonal relationship due to valueless relationship contributing to depression
Ineffective interpersonal relationship due to abusive relationship contributing to depression
Ineffective interpersonal relationship due to personal loss of partner contributing to depression

         III.     Contextual Stimuli (Identified factors directly influencing the focal stimulus)
Divorce of a family member
Adultery situation with ex-husband
Ex-husband lies/deceit
New responsibilities of a single mother
Relationship failure
Poor girlfriend relationships
Role failure
Feelings of helplessness and uncertainty on how to help family members
Past mental history

       IV.      Residual Stimuli (Potential factors which may influence the focal stimulus)
Bleak winter weather
Improper medication or mental therapy
Medication compliance issues
Inadequate sex lives
Poor eating habits
Poor exercise habits

				
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