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.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mother-and-daughter-a-cultural-tale

Document the following for the family in the video, using the Comprehensive Evaluation Note Template: 

·       Chief complaint

·       History of present illness

·       Past psychiatric history

·       Substance use history

·       Family psychiatric/substance use history

·       Psychosocial history/Developmental history

·       Medical history

·       Review of systems (ROS)

·       Physical assessment (if applicable)

·       Mental status exam

·       Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5-TR diagnostic criteria(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

·       Case formulation and treatment plan

·       Include a psychotherapy genogram for the family

Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning. 

NRNP_6645_Week2_Assignment_Rubric

NRNP_6645_Week2_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeDocument the following for the family in the video, using the Comprehensive Evaluation Note Template: • Chief complaint• History of present illness• Past psychiatric history• Substance use history• Family psychiatric/substance use history• Psychosocial history/Developmental history• Medical history• Review of systems (ROS) • Physical assessment (if applicable)(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

20 to >17.0 pts

Excellent 90%–100%

The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. The response addresses each of the required elements and demonstrates thoughtful consideration of the client family’s situation and culture.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

17 to >15.0 pts

Good 80%–89%

The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

15 to >13.0 pts

Fair 70%–79%

The assignment includes a description of the subjective and objective information for the client family but is somewhat general or contains small inaccuracies.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

13 to >0 pts

Poor 0%–69%

The assignment includes a description of the subjective and objective information for the client family but is vague or contains many inaccuracies. Or, several of the required elements are missing.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

20 pts

This criterion is linked to a Learning Outcome• Mental status exam • Differential diagnoses—Include a minimum of three differential diagnoses and include how you derived at each diagnosis in accordance with DSM-5-TR diagnostic criteria

20 to >17.0 pts

Excellent 90%–100%

The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the family in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

17 to >15.0 pts

Good 80%–89%

The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

15 to >13.0 pts

Fair 70%–79%

The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

13 to >0 pts

Poor 0%–69%

The response provides an incomplete or inaccurate description of the results of the mental status exam and/or explanation of the differential diagnoses. Or, assessment documentation is missing.

20 pts

This criterion is linked to a Learning Outcome• Case formulation• Treatment plan that includes psychotherapy interventions

25 to >22.0 pts

Excellent 90%–100%

Case formulation is thorough, thoughtful, and demonstrate critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. The response demonstrates thoughtful consideration of the client family’s situation and culture.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

22 to >19.0 pts

Good 80%–89%

Case formulation demonstrates critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions.

19 to >17.0 pts

Fair 70%–79%

Case formulation is somewhat general or does not demonstrate critical thinking…. The assignment includes a treatment plan for the client family that includes psychotherapy interventions but is somewhat general or contains small inaccuracies.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

17 to >0 pts

Poor 0%–69%

The assignment provides a vague and/or inaccurate description of the case formulation and treatment plan for the client family. Or, many of the required elements are missing.

25 pts

This criterion is linked to a Learning Outcome• A psychotherapy genogram for the family

20 to >17.0 pts

Excellent 90%–100%

The assignment includes an accurate, clear, and complete genogram of the client family. The documentation style is consistent and a key is provided.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

17 to >15.0 pts

Good 80%–89%

The assignment includes an accurate genogram of the client family. The documentation style is consistent and a key is provided.

15 to >13.0 pts

Fair 70%–79%

The assignment includes a genogram of the client family but is somewhat limited or contains factual inaccuracies or inconsistencies in documentation style.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

13 to >0 pts

Poor 0%–69%

The genogram provided is vague or contains many inaccuracies. Or, the genogram is missing.

20 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided which delineate all required criteria.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

5 to >4.0 pts

Excellent 90%–100%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts

Good 80%–89%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

3 to >2.0 pts

Fair 70%–79%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

2 to >0 pts

Poor 0%–69%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time…. No purpose statement, introduction, or conclusion were provided.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

5 to >4.0 pts

Excellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts

Good 80%–89%

Contains 1 or 2 grammar, spelling, and punctuation errors.

3 to >2.0 pts

Fair 70%–79%

Contains 3 or 4 grammar, spelling, and punctuation errors.

2 to >0 pts

Poor 0%–69%

Contains many (≥5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

5 to >4.0 pts

Excellent 90%–100%

Uses correct APA format with no errors.

4 to >3.0 pts

Good 80%–89%

Contains 1 or 2 APA format errors.

3 to >2.0 pts

Fair 70%–79%

Contains 3 or 4 APA format errors.

2 to >0 pts

Poor 0%–69%

Contains many (≥5) APA format errors.

5 pts

Comprehensive Psychiatric Evaluation Note on Family Assessment Essay

Subjective:

CC (chief complaint): “I think I need more to be done. I’m not done. No.”

HPI: Ms. P, 40, and her daughter, Sharleen, aged 23, are Irani immigrants present for a psychiatric consultation with the family therapist and a reflecting team. The family therapist reports that he had seen the family for about a year and a half. Ms. P was married off an immature 14-year-old girl, experiencing nightmares and abuse from her ex-husband. Ms. P and her two daughters and sons immigrated to the USA 12 years ago, leaving behind another daughter, Shireen, now age 21, who joined the family two years ago. The sons are aged 18 and 15. Since then, chaos in the household has prompted the need for therapy.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Furthermore, the therapist reports that the mother of five lives with traditional living methods while her daughters try to detach themselves from Patti, grow independently, and find their individuality. Ms. P had two failed surgeries on her feet and is now disabled. Moreover, this has created more tension and anxiety in the family. She is in constant pain. The mother of five has been referred to a psychiatrist because she feels hopeless and helpless. She claims her children are out of control, she cannot be in charge, and they no longer need her.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

So far, the therapist has helped Patti achieve awareness that there are individual and collectivist ways of living that she needs to respect and understand that the children are growing up and would detach themselves from her to be able to grow on their own. Patti understands that as the kids grow, they will live and should not depend on them most of the time, try to live alone, take care of her things and problems, respect the children and give them their freedom. However, Ms. P believes that there is more to be done about her situation. She would want to learn to lead her life alone and not depend on her children a lot. Ms. P argues that in her culture, when parents get old, the kids are always there for the parents, and they had a big argument about it last night. Sharleen complains that her mother wants to control her life, choose her friends and happiness, and spend too much time with her, yet she has things to do. Ms. P does not get along with her eldest son. However, her children expect her to be positive and achieve better health outcomes, well-being, and independence. Sharleen complained that Ms. P does not want to allow them to grow independently and own responsibility and suppress their opinions.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

 Psychotherapy Genogram

21

Father

Brother

Brother

Shireen

Sharleen

Sheela

Perceived Neglect

Distant

23

24

15

18

Ms.

Key

Estranged

Intimate partner violence

Separated

Sexual/Physical abuse

Unknown

Past Psychiatric History: No history of mental health issues.

General Statement: Ms. P, Sharleen, and Sheela entered therapy a year and a half ago.

Hospitalizations: No history of hospitalization.

Medication trials: No history of medication trials.

Psychotherapy or Previous Psychiatric Diagnosis: No previous psychiatric diagnosis. The client has been in therapy for one and a half years.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Substance Use History: No history of alcohol or substance use.

Family Psychiatric/Substance Use History: No psychiatric diagnosis or substance abuse history.

Social History: Ms. P is an Irani immigrant, separated from her abusive husband, who married her at age 14. She has five children, three daughters and 2 sons, alive and healthy. She lives with her sons, while her daughters live away from home. She is disabled and unemployed. Has no significant legal history.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Medical History: No history of illness, but she has had foot surgeries. No history of head injuries or seizures.

Current Medications:  No current medication.

Allergies: NKFDA.

Reproductive Hx: Gravida 5, Para 5. No mention of menstrual or sexual activity. 

ROS:

GENERAL: There is no weight loss, fatigue, or fever.

HEENT: No visual or hearing loss. No nasal congestion or sore throat.

SKIN: No skin rashes or itching.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

CARDIOVASCULAR: No chest pain, palpitations, discomfort, or pulmonary edema.

RESPIRATORY: No breathing difficulties, unproductive or productive cough. GASTROINTESTINAL: No nausea or vomiting. No anorexia. No abdominal pain/constipation/diarrhea.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

GENITOURINARY: No dysuria or hematuria.

NEUROLOGICAL: No paralysis, numbness, or tingling. No headache or dizziness.

MUSCULOSKELETAL: No muscle pain or stiffness. No, joint or back pain.

HEMATOLOGIC: No ease of bleeding or bruising.

LYMPHATICS: No history of splenectomy. No enlarged nodes.

ENDOCRINOLOGIC: No polyuria, polydipsia, or polyphagia.

Physical Exam:

Completed by PCP.

Vital Signs: T- 98.5 R 16 107/74 Ht 5’6 Wt. 120lbs

Diagnostic Results: The Beck Depression Inventory (BCI) is a questionnaire evaluating the severity of depression in individuals with or without depression (Hubley, 2021). The client presents symptoms of depression through observed attitudes, and symptoms frequently occur with known determinants. BCI is reliable and sensitive to depressive symptoms.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Assessment

Mental Status Examination: Ms. P and the daughter were appropriately dressed for the occasion and weather. They are alert and oriented in all spheres. They are cooperative and make appropriate eye contact. Ms. P’s affect is in full range with the stated mood or anxiousness. Her speech is clear, with poor language ability. She is resigned and conflicted about her imminent situation. There was no abnormal psychomotor activity observed during the interview. Her thought process is tangential and logical, and she has a good insight into the situation. The mother of five and her daughter have good insight, judgment, attention, and concentration. No evidence of suicide or homicide. The client is at no risk to herself or others.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Differential Diagnoses:

1. Adjustment Disorder (AD) – The primary precipitating factor of the family situation is the children’s intention to leave their home and their mother and live independently. This situation is causing Ms. P anxiety, and with her disability, she seems helpless and hopeless. The diagnostic criteria for AD are behavioral and emotional reactions towards a marked stressor(s) (American Psychiatric Association [APA], 2019). The reactions are often out of proportion and are demonstrated by the daughter’s claim that the mother wants to control every aspect of their life, including happiness and friends, leading to low mood, hopelessness, helplessness, and bad days. This is the primary diagnosis.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)
2. Posttraumatic Stress Disorder (PTSD) – The primary predisposing factor is the family history of trauma. Ms. P has a history of intimate partner violence, making her excessively protective of her children. Besides, Shireen’s history of sexual and physical abuse further causes chaos in the family. Lastly, Ms. P is dealing with the trauma of failed sugaring that left her disabled, unable to walk or work, and in constant pain. The diagnostic criteria for PTSD include the actual or threatened experience of a traumatic event (s), leading to psychological responses, flashbacks, distress, involuntary dreams, and thoughts. These traumatic events have defined the family situation.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)
3. Separation Anxiety Disorder (SAD) – The other precipitating factor to the family situation is how the daughters try to incorporate their bicultural life and how the family responds to the change in culture and life as immigrants. The desire and actual move by the daughters to live a separate and independent life is of great concern considering the role of children in taking care of their parents when old or sick back in Iran, which is her situation at the moment, and she wants to spend more time with them. The diagnostic criteria for SAD include perceived separation from an individual a person is attached to (APA, 2019). This separation causes recurrent distress, worry, and nightmares. The affected individual refuses to let go, be alone, or avoid being alone. This is a secondary diagnosis.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Reflection

Considering the presented symptoms, I agree with the preceptor’s diagnosis. The overall need for the consultation is to address the history of trauma that the family has and the family’s response to their bicultural experience and life as immigrants. The family history of trauma and the daughters’ response is the precipitating factors to the client’s emotional and physical attachment. In this case, Ms. P understands the differences in individual lives and the need to learn to live by herself, yet she is still hesitant to accept (Bacigalupe, 2003). Helping the family manage the traumatic past will be crucial in helping Ms. P with the emotional and behavioral response to her current relationship with the daughters.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Case Formulation and Treatment Plan

Initiate trauma-focused cognitive-behavioral family therapy (TF-CBFT) as the first-line treatment. TF-CBFT assists clients in changing their irrational and self-defeating beliefs to manage their emotional and behavioral responses (Hutcheson, 2019). The intervention is based on the assumption that dysfunctional family relationships, behaviors, emotions, and cognitions are interlinked, and family members can make a change by learning appropriate communication and coping skills.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Treatment aims to help the family members, notably Ms. P, overcome the feelings and behaviors associated with the need to remain independent and accept that her daughters will not be with her longer. Besides, the intervention will help Ms. P accept her disability, find ways to remain independent and allow children to offer their mother support. The intervention will also allow Shireen to forgive her mother, allowing the family to remain united even though they will eventually be apart.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

Initiate Sertraline 25mg PO QD for Ms. P. Sertraline is recommended to help manage anxiety. Mahase (2019) asserts that sertraline is an effective medication for managing anxiety symptoms, including irritability and restlessness shown by Ms. P. Side effects are communicated, and the Client’s Crisis Line is given in case of crisis. The family is to return to the clinic every four weeks for consultation and revaluation.(Comprehensive Psychiatric Evaluation Note on Family Assessment Essay)

References

American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders (7^th ed.). American Psychiatric Publishing, Inc.   

Hubley, A. M. (2021). Beck depression inventory. In Encyclopedia of Quality of Life and Well-Being Research (pp. 1-11). Cham: Springer International Publishing. Available at: https://link.springer.com/referenceworkentry/10.1007/978-3-319-69909-7_156-2   (Accessed 6 December 2022)

Bacigalupe, G. (Director). (2003). Mother and Daughter: A Cultural Tale.  [Video/DVD] Thousand Oaks, CA: Masters work Productions. Available at: https://search.alexanderstreet.com/view/work/bibliographic_entity%7Cvideo_work%7C2414638  (Accessed 6 December 2022)

Hutcheson, C. L. (2019). Cognitive behavioral family therapy. In L. Metcalf (Ed.), Marriage and family therapy: A practice-oriented approach (pp. 95–118). Springer Publishing Company.