family assessment example

A-62 APPE N DIX H FAMILY ASSESSMENT TOOLS

cided that, given their lifestyles and personalities, theywanted to adopt an older child between 3 and 5 years ofage and not an infant. Ben wanted to adopt a son. Marewas not selective of the gender. Ben felt that the issue ofrace was important to him. He felt that he might have dif-ficulty bonding with a child of dark skin as his own fam-ily. Because of Ben’s immediate family origins fromFinland, they decided to adopt a child from easternEurope. Russia was selected because of its historical tieswith Finland.

Mare reviewed videotapes of 40 children and selectedthe top male children for them to select from. Mare is a pe-diatric nurse and was determined to be the one to makethe decisions about health. After viewing the films numer-ous times and reviewing a medical examination, Alex wasthe young child of choice. Ben and Mare made a formalpetition to adopt Alex.

The process has taken 6 months. They are currentlywaiting for the final paperwork to arrive from the Russiangovernment, which is expected in the next few days. Theyare in the midst of preparing their home for the arrival ofAlex. They will both travel to Russia in 2 weeks to pick himup, complete the formal adoption process in Russia, andtravel home together as a new family.

They are nervous and excited about the adoption. Theyare concerned about how Alex will adjust to them and themove to America. They are concerned about how adopt-ing a 4-year-old will change their lifestyle. The preparationof their home for the arrival of Alex has been time con-suming. The arrangements for travel to Russia are being fi-nalized. Ben had taken 2 years of Russian 20 years ago;both are currently taking individual language tutoring inRussian. Ben and Mare are currently working full-time.Mare plans to continue working full-time after they adoptAlex, but she does have a reduced workload for the next 4 months. They plan to have Alex attend full-timepreschool.

The initial assessment of the Jeddi family involved theuse of two assessment approaches with their respective in-struments, guidelines, a genogram, and an ecomap. A sum-mary of the findings from this assessment follows.

FAMILY SYSTEMS STRESSOR STRENGTH IN-VENTORYThe FS3I is presented, which focused on the Jeddi familystressors and strengths to create a plan of action. Ben andMare were interviewed together in their home by thenurse. Each person completed the FS3I, which providedindividual and composite scores. Figure H-1 presents acompleted genogram. Figure H-2 shows the Jeddi familyecomap. Figures H-3 and H-4 provide the scoring for thequantitative summary of stressors and strengths. A

The Jeddi family is a real family in a real situation. Theycame to the attention of the nurse when the family was re-ferred to the county home health agency for a baselinefamily assessment with their impending adoption of a 4-year-old boy from Russia. This upper middle classCaucasian family consists of Ben (age 51), Mare (age 43),and the son they will adopt, Alex (age 4). See Figure H-1for the Jeddi family genogram and Figure H-2 for the Jeddifamily ecomap.

Ben and Mare have been married for 8 years. Ben has aPhD in chemical engineering and does consulting work.His business is located in the caretaker apartment locatedin the basement of their home. Mare has a PhD, is a pedi-atric nurse, and teaches at a private university. They areadopting a 4-year-old boy from Russia. Mare has a diag-nosis of infertility after 2 years of trying to have a biologicchild and extensive testing. The infertility issue was a sig-nificant loss for both Ben and Mare. The couple consid-ered in vitro fertilization. Mare decided against this ap-proach because she felt the risks of failure of pregnancyand miscarriage were too great. Ben felt that this wasMare’s decision to make as it more directly involved herphysical and mental health. He supported Mare’s decisionto not pursue in vitro fertilization.

Mare initiated the discussions about adoption. The de-cision to adopt a child was reached in May of this year af-ter a year and a half of discussion and investigation.Initially, Ben was not equally committed to the concept ofadoption and had a longer grieving process over their in-ability to have a child together than Mare. The issue of bi-ologic heritage and the loss of blood lineage were more sig-nificant to Ben. The significant issue for Mare was the lossof being a parent and raising a child.

The couple investigated several adoption agencies andattended potential adoptive parent classes a year and a halfago. At that time, Ben was not ready to make a commit-ment to adoption. The topic of adoption repeatedly wasdiscussed by the couple over the course of the next year.In January 1994, the couple again seriously consideredadoption. Mare investigated several adoption agenciesagain, as she was not satisfied with the one they selectedthe last time. A local adoption agency was found to besupportive and informative for them. The couple attendedan information meeting. After much intense emotionaldiscussion, the couple pursued more information aboutadoption with the support personnel from the agency. Atthe end of May, Ben and Mare decided they wanted toadopt a child and completed the application process.

Both Ben and Mare feel this was an emotional time forthem. After they made their decision to adopt, the nextsteps were to decide from which country they wanted toadopt a child, the child’s age, and which child. They de-

H.3 Case Example of Family Assessment

Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

APPE N DIX H FAMILY ASSESSMENT TOOLS A-63

Mare(43)

Tom(4)

Adoptionservice inArkansas

Sister

Friends

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Russia

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Local adoptionservice

Ben(51)

WorkMother

StrongTenuousStressfulEnergy flow

Key

Figure H-1

Figure H-2

72 yearsResp. failure

Jeddi family

80 yearsAlzheimer’sKyptosisInstitutionalized

Ben(51)EngineerOverweightHypertensionHigh cholesterol

Tom(4)�5% height and weightSpeaks only RussianOrphan since 3 months

OverweightHypertensionEmphysema

@ 4 years of ageOct. 1994

62 yearsLymphoma

Sepsis

M 1986

Generation 1

Date

Family name

Completed by

Generation 2

Generation 3

Mare(43)NurseObeseInfertility



FRIEDMAN’S FAMILY ASSESSMENT FORM

Identifying dataBen and Mare JeddiPortland, MaineType of family: NuclearEthnic background: Ben comes from a Finnish back-

ground. Mare has no particular ethnic identityReligious: No affiliationSocial class: Upper middle classLeisure activities: Travel, gardening, musicOccupations: Ben, consulting chemical engineer.

Mare, pediatric nurse and university faculty

Developmental stage and history of familyThe family’s present developmental stage cannot be de-fined in the conventional family life cycle. Ben and Marehave been married for 8 years, so they do not fit the cate-gories for beginning families or families with children.However, they are in transition and, with the adoption ofa 4-year-old boy, the family will fit into the classical fam-ily life cycle stage of family with preschooler.

Ben comes from a nuclear family of origin; however,his parents were divorced after 30 years of marriage. Marecomes from a nuclear family of origin.

Environmental dataThe family live in an upper-middle-class urban neighbor-hood that is ethnically diverse. They are within close dis-tance of schools, hospitals, fire department, and shoppingareas. The neighborhood is clean and relatively safe, asthere have been a few burglaries in the neighborhood.Both attend the neighborhood community meetings. Thefamily is centrally located only 8 blocks from freewaysaround town, 2 miles from downtown, and 5 blocks froma bus route. Ben works in the home, where the basementcaretaker apartment has been converted into his office andlaboratories. Mare works at the university, which is 4 milesaway. She often rides her bike to work.

Their home is a 75-year-old brick home that has fourlevels. It is situated on the edge of a hollow. The home iswell kept but old. Both Ben and Mare enjoy their homeand spend a lot of time there. They are slowing remodel-ing. The house is safe, but with the adoption of a 4-year-old boy, several safety factors need to be addressed. Thereis no medicine cabinet in the bathroom and medicines areeasily within reach of a 4-year-old. The cleaning solutionsare kept under the sinks in the kitchen and the bathroom.The patio above the garage does have a railing, but a 4-year-old may be tempted to walk on it. A fire plan needsto be made for the family because all of the bedrooms areon the top floor, which is three levels above the ground.

qualitative summary (Figure H-5) presents a brief pictureof the family stresses and strengths and served as the guidefor the family care plan (Figure H-6).

The general stressors of the family were the impendingadoption of Alex, issues of family nutrition and dieting,and lowered self-image for both Ben and Mare. Mare wasfound to have a higher general stress level than Ben. Shestates that in addition to the above stressors she is con-cerned about: stress relative to housekeeping issues, an on-going physical problem with her knee, and guilt for not ac-complishing more than she presently is able. Ben notedthat issues related to his mother, who has Alzheimer’s dis-ease and lives in an assisted living center, causes him addi-tional stress. The nurse rated their general and specificstressors higher than both Ben and Mare rated themselves.

The specific stressor identified by Ben that is causinghim the most stress is the impending adoption of Alex. Heis concerned about time management with work and a newfamily member. The additional stress of his mother’s careis requiring a lot of his time. She is well taken care of in anassisted living center, but he is concerned about her ad-vancing dementia. At present he is actively involved inrenting out his mother’s home. The specific stressor iden-tified by Mare was how she is going to manage food prepa-rations and meal times after they adopt Alex. She statedthat cooking and meal preparation are currently a bigproblem for her. Mare stated that Ben does not help withfood preparation or clean up now. They both eat on dif-ferent schedules. She is concerned about family dinnersand feels this is an important time for them with Alex.Food preparation is not a new issue for them. She statedthat she feels pressured and “like a failure” because shedoes not manage this aspect of their family life well now,before the addition of Alex. In the past the family hashired a cook which was a “excellent solution” for them.The have been without a cook for 2 years now after theirprevious cook moved out of state.

The strengths of this family are many. They scored theirindividual strengths inventory almost identically, whichdemonstrates a similar perception of their family unit. BothBen and Mare viewed their family and each other as expe-rienced problem solvers. They have good, open communi-cation between them and feel that the adoption of Alex haseven brought them closer together. They recognized thatmuch of their current stress is related to the unknownabout Alex. They feel that once they meet Alex that theywill be able to work together to solve their problems.

The nurse concluded that this family has the strengthsthey need to adapt to their new family life cycle of a fam-ily with a preschooler. In looking at the ecomap, the fam-ily is found to be well supported by resources. They are re-sponsive to information provided to them and ideassuggested by others for them to consider in their problemsolving.

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Family Systems Stressors: General Family Systems Stressors: SpecificScores forWellness

and Stability

Scores forWellness

and StabilityFamily MemberPerception Score

Family MemberPerception Score

Clinician PerceptionScore


Directions: Graph the scores from each family member inventory by placing an “X” atthe appropriate location. (Use first name initial for each different entry and different colorcode for each family member.)

Family Systems Stressor-Strength Inventory (FS3I)Quantitative Summary

Family Systems Stressors: General and SpecificFamily and Clinician Perception Scores

5.0

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• PRIMARY • SECONDARY• TERTIARY

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1.0 - 2.32.4 - 3.63.7 - 5.0

• Breakdown of numerical scores for stressor penetration are suggested values

Figure H-3Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.


Family Systems StrengthsSum of StrengthsAvailable forPrevention/Intervention

ModeFamily MemberPerception Score


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Directions: Graph the scores from the inventory by placing an “X” at the appropriate locationand connect with a line. (Use first name initial for each different entry and different colorcode for each family member.)

• PRIMARY • SECONDARY• TERTIARY

Prevention/Intervention Mode: Flexible LinePrevention/Intervention Mode: Normal LinePrevention/Intervention Mode: Resistance Lines

1.0 - 2.12.2 - 3.63.7 - 5.0

• Breakdown of numerical scores for stressor penetration are suggested values

Family Systems Stressor-Strength Inventory (FS3I)Quantitative Summary

Family Systems StrengthsFamily and Clinician Perception Scores



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Part I: Family Systems Stressors: General

Summarize general stressors and remarks of family and clinician. Prioritize stressors according toimportance to family members.

Part II: Family Systems Stressors: Specific

A. Summarize specific stressor and remarks of family and clinician.

B. Summarize differences (if discrepancies exist) between how family members and clinician vieweffects of stressful situation on family.

C. Summarize overall family functioning.

D. Summarize overall significant physical health status for family members.

E. Summarize overall significant mental health status for family members.

Part III: Family Systems Strengths

Summarize family systems strengths and family and clinician remarks that facilitate family health andstability.

Family Systems Stressor-Strength Inventory (FS3I)Qualitative Summary

Family and Clinician Remarks

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Family structureCommunication is a strength of this family. There is anopen relationship and communication pattern betweenBen and Mare. Both are very verbal and expressive abouttheir feelings, opinions, and needs. Because of this open-ness, they state that there is often conflict and arguing be-tween them. However, they feel that they are good at con-flict resolution. At times, however, the argument does getout of control and takes a personal attack format. Whenthey realize this, usually Mare suggests that they take upthe conversation at a later time when they can both ap-proach the topic more calmly. They are not worried aboutarguing in front of their son. They feel that their open,honest communication will be helpful in raising their son.

The decision making of the family is by consensus forimportant issues that affect the lives of both members.Otherwise, the decision-making style is accommodation.The power and decision making is more situational in thatwhoever has more experience with certain issues will influ-ence the decisions. For example, Mare is a nurse and has thereferent power in health-related issues. Ben is a chemical en-gineer. He has referent power for concerns about fixingthings in the house or with cars. Both state that a strengthof their family is that they are both known problem solvers.

The role structure is typical relative to gender. Maredoes the cooking, laundry, house cleaning, shopping, andkinship roles. Ben does the lawn mowing, carries out thegarbage, and services the cars. Mare feels that she has moreroles and expected behaviors of her than Ben does. Theyboth work full-time outside the home. Both state they areconcerned about role overload and time management is-sues with the adoption of their 4-year-old. Mare knowsthat she will be the primary caregiver but is not sure howmuch or in what way Ben will assist with these new role re-quirements. Ben is concerned about how much time thenew child will demand and his ability to juggle all of thesework responsibilities and family responsibilities.

The family values are clear and shared by both Ben andMare. The family values: education, open, honest com-munication, family, health, diversity, caring and compas-sion for others.

Family functions

Affective function

Ben and Mare have a close, caring relationship anddemonstrate a reciprocal emotional relationship. They area close, cohesive family. They are excited about expandingtheir family with the adoption of Alex. They each statethat the other is a major support person in their lives. Thefamily has closed boundaries but does look to extendedfamily members for needed support. They express concernabout their son’s adjustment to them as parents, because

he has lived in an orphanage in Russia since the age of 3months. They have investigated as much as possible abouthow other children adapt to their new situations. Theyplan to go to Russia to pick up their son, which will givethem access to information about rules and rituals he is fa-miliar with in the orphanage, and plan to institute them intheir home.

Socialization function

Ben and Mare talk about the importance of parenting theirson. They have openly discussed discipline to be used,which will be time-out. They plan to be involved in thechild-rearing practices of their son. Their son will be infull-time preschool. They plan to be active in the educa-tion process of their son.

Health care function

The family has a primary care physician for Ben andMare, but they have not selected a pediatrician for theirson. Ben sees the physician regularly for management ofhypertension and high cholesterol. Mare rarely sees thedoctor. The have a medical report for their son. He ap-pears to be in good health, except that he is below thefifth percentile for height and weight. He is current on im-munizations except hepatitis. They both have dentalcleaning and examinations every 6 months. They valuehealth, yet both are overweight. Mare is obese. A majorconcern for Mare is regular meal preparation for their son.At present, Ben and Mare do not eat together for dinneron a regular basis. In the past they have hired a cook toensure that healthful meals were available, especially withMare working full-time.

Family copingThe short-term stressors for this family are the imminentadoption of their 4-year-son from Russia in 3 weeks. Theyare concerned about his adaptation to his new environ-ment, his ability to learn English, and how there lives willchange with this adoption. Long-term stressors are not anissue at this time.

The family has a large repertoire of successful copingstrategies. They have a pattern of problem-solving issues tothe best of their ability. They are seeking out informationand garnering support from people and resources accept-able to them. They are a well-adjusted family unit. Thefamily is open to education and information.

Summary of assessmentsIn summary, both assessment approaches provided impor-tant information for the nurse and family to create a planof action. There was some overlap of information, but thewhole picture of the family was enhanced by merging datafrom both assessment tools.


family assessment example

Documents

real family

jeddi family genogram

ben age

new family

figure h

mare age

ben andmare

alex age