Explain why it is important to use theory in family therapy. How does theory help social workers understand and assess a family? Apply systems theory and a

Hernandez Family Episode 1

© 2013-2021 Walden University, LLC 1

Hernandez Family Episode 1 Program Transcript

JUAN HERNANDEZ: But we didn't do anything wrong. That woman, that social worker, who came to our house, I told her, me and Elena, we decide what's best for our boys, not her. Telling us we punish to hard. She doesn't know anything about us.

ELENA HERNANDEZ: We give our sons a good life. We love them very much. It's not fair what she said about Juan and me. We're good parents.

FEMALE SPEAKER: Mrs. Hernandez, I understand how difficult this is for you–

JUAN HERNANDEZ: I don't think you do. Everything that we do, we do for them, everything. We work hard. We take care of them. And when they don't follow the rules, they get punished, strictly. The old fashioned way.

ELENA HERNANDEZ: Shh. Quiet. I told you.

JUAN HERNANDEZ: Sometimes I'm not strict enough with them. Look, I punish my sons the way I see fit. That's the only way they are going to learn. That's how we learned from our parents, right? Nobody took parenting classes. That's ridiculous.

FEMALE SPEAKER: I understand you're angry. And you're raising your children the way you were brought up to do. But ACS has required that you do this.

JUAN HERNANDEZ: What if I don't want to be required?

ELENA HERNANDEZ: I have a question.

FEMALE SPEAKER: Of course.

ELENA HERNANDEZ: If we go through with this, the things we talk about with you, will it be private?

JUAN HERNANDEZ: But we have not agreed to do this.

ELENA HERNANDEZ: I don't want to be here either. But I don't want to loose our children. Would it be private, what we talk about?

FEMALE SPEAKER: The information we share is between us. The only exception to that is if one of you says you're going to hurt yourself or hurt someone else. In that case, I have to report it to the ACS worker. But everything else is strictly confidential.

Hernandez Family Episode 1

© 2013-2021 Walden University, LLC 2

So how do you think we can work together to make this a positive experience for both of you?

JUAN HERNANDEZ: Parenting classes, really? What about the bills? I'm not going to be able to work overtime.

ELENA HERNANDEZ: If we do what we're supposed to do, would it be OK with our family?

FEMALE SPEAKER: There are no guarantees. But here's what I can say. We'll all work together to create a plan based on what the ACS worker has required and recommended. Then it will be up to her what the outcome will be.

So shall we make a plan?

Hernandez Family Episode 1 Additional Content Attribution MUSIC: Music by Clean Cuts Original Art and Photography Provided By: Brian Kline and Nico Danks

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© 2022 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

Hernandez Family

SOCW 6121

Juan Hernandez (27) and Elena Hernandez (25) are a married Latino couple who were

referred to the New York City Administration for Children Services (ACS) for abuse

allegations. They have an 8-year-old son, Juan Jr., and a 6-year-old son, Alberto. They

were married 7 years ago, soon after Juan Jr. was born. Juan and Elena were both born

in Puerto Rico and raised in Queens, New York. They rent a two-bedroom apartment in

an apartment complex where they have lived for 7 years. Elena works as babysitter for

a family that lives nearby, and Juan works at the airport in the baggage department.

Overall, their physical health is good, although Elena was diagnosed with diabetes this

past year and Juan has some lower back issues from loading and unloading bags.

They both drink socially with friends and family. Juan goes out with friends on the

weekends sometimes to “blow off steam,” having six to eight beers, and Elena drinks

sparingly, only one or two drinks a month. Both deny any current drug use. While they

do not attend church regularly, both identify as being Catholic and observe all religious

holidays. Juan was arrested 4 years ago for drug possession and was sentenced to 6

months in jail. Elena has no criminal history. They have a large support network of

friends and family who live nearby, and both Elena’s and Juan’s parents live within

blocks of their apartment and visit frequently. Juan and Elena both enjoy playing cards

with family and friends on the weekends and taking the boys out to the park and beach

near their home.

ACS was contacted by the social worker from Juan Jr.’s school after he described a

punishment his parents used when he talked back to them. Juan Jr. told the social

worker that his parents made him kneel for hours while holding two large books (one in

each hand) and that this was a punishment used on multiple occasions. The ACS

worker deemed this a credible concern and made a visit to the home. During the visit,

the parents admitted to using this particular form of punishment with their children when

they misbehaved. In turn, the social worker from ACS mandated the family to attend

weekly family sessions and complete a parenting group at their local community mental

health agency.

In her report sent to the mental health agency, the ACS social worker indicated that the

form of punishment the parents used was deemed abusive and that the parents needed

to learn new and appropriate parenting skills. She also suggested they receive

education about child development because she believed they had unrealistic

expectations of how children at that developmental stage should behave. This was a

particular concern with Juan Sr., who repeatedly stated that if the boys listened, stayed

quiet, and followed all of their rules, they would not be punished. There was a sense

from the ACS worker that Juan Sr. treated his sons, especially Juan Jr., as adults and

not as children. This was exhibited, she believed, by a clear lack of patience and

understanding on his part when the boys did not follow all of his directions perfectly, or

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© 2022 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

when they played in the home. She mandated family sessions along with the parenting

classes to address these issues.

Intake Session

During the intake session, when the social worker met the family for the first time, both

Juan and Elena were clearly angry that they had been referred to parenting classes and

family sessions. They both felt they had done nothing wrong, and they stated that they

were only punishing their children as they were punished as children in Puerto Rico.

They said that their parents made them hold heavy books or bags of sand as they

kneeled, and they both stressed that at times the consequences for not behaving had

been much worse. Both Juan and Elena were “beaten” (their term) by their parents.

Elena’s parents used a switch, and Juan’s parents used a belt. As a result, they feel

they are actually quite lenient with their children, and they said they never hit them and

they never would. Both stated that they love their children very much and struggle to

give them a good life. They both stated that the boys are very active and don’t always

follow the rules, and the kneeling punishment is the only thing that works when they

“don’t want to listen.”

They both admitted that they made the boys hold two large books for up to 2 hours

while kneeling when they did something wrong. They stated the boys are “hyperactive”

and “need a lot of attention.” They said they punish Juan Jr. more often because he is

particularly defiant and does not listen and also because he is older and should know

better. They see him as a role model for his younger brother and feel he should take

that responsibility to heart. His misbehavior indicates to them that he is not taking that

duty seriously and should therefore be punished, both to learn his lesson and to show

his younger brother what could happen if he does not behave.

During the intake session, Juan Sr. stated several times that he puts in overtime any

time he can because money is “tight.” He expressed great concern about having to

attend the parenting classes and family sessions, as it would interfere with that

overtime. Elena appeared anxious during the initial meeting and repeatedly asked if

they were going to lose the boys. The social worker told them it would be up to them to

complete those plans successfully. The social worker offered support through this

process and conveyed empathy around their response to the situation.

I

3

Assessment ofFamilies

Assessment of risk and protective factors and their interaction is a key step in using a resiliency-based approach to counseling families. The counselor and the family are partners in a collaborative venture to understand the life space of the family, the distress experienced by family members, the potential resources and sources of resiliency for the family, and the barriers that might prevent the family from accessing these resources. The assessment process also sets the tone for the working partnership between the family and the counselor. As F. Walsh (1998) indicated

"A common approach regarding family resiliency is the conviction that there are strong advantages to working with family members in a col­ laborative manner and finding solutions to shared problems. Family therapy is most effective when it identifies key processes for resiliency. Assessment needs to be broad based to include each family's strengths and vulnerabilities on multiple system dimensions in relation to the challenges they face, their resources and constraints, their social environment, and their developmental passage:' (p. 16)

This broad-based assessment process is a critical step in guiding decisions regarding the appropriate intervention strategies because the needs and resources of each family are unique to their situation.

Resiliency-Based Approach to Assessment

Families are often discouraged and demoralized when they come for help. Before seeking help from a social worker or other professional counselor, they have typ­ ically tried their usual coping strategies and turned without success to their in­ formal support systems within their extended family, friends, and other sources of help. In terms of the family coping models, their efforts to cope have led them to a state ofmaladaptation or crisis. Sometimes, their efforts have in turn created

64

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65 Assessment of Families

yet another set of demands on the family requiring further coping strategies and changes that have proved insufficient to meet these demands. They might have been sent for counseling by organizations with authority in the community with a message that they need help because they were unable to handle the problem. These are clearly not the descriptions of families who feel empowered. This potential demoralization of families is important. It is not only painful for the individuals involved but also depletes the sense of coherence and self-efficacy that support resiliency. Rather than being strengthened by viewing themselves as successful in and capable of addressing life situations, families can become even less able to handle already-difficult situations. Their family stories risk becoming problem saturated.

Assessment from a resiliency-based perspective thus seeks to support the resil­ iency of families by explicitly identifying sources of resiliency within the family in ways that can engender hope to family members. The social worker searches for signs of strength within the family and protective factors within the life space of the family. Evidences of strength and tools for resiliency are not merely noted in charts but acknowledged as such with family members throughout the process. This enhances the family's sense of self-efficacy and mastery and helps make them a more effective partner.

Assessment also identifies areas offamily functioning that need to be strengthened or addressed as well as stressors within the environment. Problematic communica­ tion patterns, unresolved family conflicts, lack ofeffective parenting skills, and iso­ lation from potential sources ofcommunity support represent several areas that can need strengthening. Community violence, lack of educational opportunities, and high levels ofunemployment represent community stressors.

While a resiliency theoretical framework helps guide assessment and treat­ ment decisions, use of this framework does not limit the family counselor to a single treatment model. Based on the results of the assessment of the specific risk and protective factors identified at the individual, family, and contextual levels, a variety of treatment approaches might be appropriate. The following brief vignettes illustrate how very different patterns of risk and protective factors can be present:

• The Anderson family has recently moved to the community and has not had the op­ portunity to develop any support network within the community. Their youngest child has developed a serious illness. The family members can communicate with each other about the situation, ways to address it, and their response to it. At the same time, they are feeling very alone because they lack any source ofsupport within their new community.

• The Bowen family is concerned about one oftheir children, who is demonstrating mis­ behavior in school. The school has contacted them and asked them to be partners in creating a reinforcement system that will discourage such behavior. The parents love

66 INTRODUCTION TO RESILIENCY-BASED PRACTICE

their children deeply. At the same time, they are reluctant to set limits on their son. Both parents grew up in very abusive family situations, and they promised themselves that they would be loving parents to their children. They are reluctant to punish their child and have not developed a repertoire ofparenting skills in this area.

• The Cutler family is struggling with severe .financial problems. The father developed cancer, which has limited his ability to work and has caused the family severe.financial hardship. Fortunately, they have potential resources from their extendedfamily if they can ask for help.

• The Dodgefamily is worried about their teenage son, who has begun to skip school and abuse substances. The parents love their son and are desperate to try to find a way to stop his behavior. They have begun to threaten him, but their son in turn just says that he will run away.

• The Eduardo family had lived in their home for many years. It had been the center of their family, and they were very proud of what they had been able to accom­ plish. Unfortunately, their home was destroyed in the recent hurricane. They not only are uncertain if their insurance will be adequate to purchase a new home, but also are grieving the loss ofa home that had so many good memories attached to it. In the meantime, they can live temporarily with the father's brother and his family.

These abbreviated vignettes illustrate various family patterns and circumstances that would require different intervention strategies. Based on the assessment, the

counselor in partnership with the family identifies the appropriate and effective ways to help the family members cope with the current sources of distress and

strengthen protective factors for the present and, it is hoped, ones that will serve them for the future. Use ofa resiliency approach in this manner can facilitate clinical judgment regarding the selection ofappropriate intervention strategies. Discussion

of assessment and selection of intervention approaches must recognize that this is

an ongoing process subject to revision based on new information and developments

within the life space of the family. Chapter 1 describes family and contextual characteristics that support resil­

iency (Table 1.1). Family characteristics include belief systems that engender hope, a sense of mastery and self-efficacy; a sense of purpose and meaning; family or­ ganizational patterns that promote effective communication, a balance offlexibility and cohesion, and adequate leadership; positive interactions and trust; humor;

problem-solving and coping skills to address the problem at hand; and appropriate support systems in the wider community. Risk factors can be contextual: poverty,

community disorganization and violence, and lack of economic and educational opportunities. They can also reflect family patterns that lead to conflict, lack of leadership, poor coping skills, rigidity, or chaotic family patterns. Families can also be isolated from potential support systems or appropriate resources can be absent

from the community.

67 Assessment of Families

Assessment Process

The assessment process can use a variety of strategies, including formal assess­ ment tools, visual devices, an interview format, observation, information obtained from others, and the social worker's general knowledge of the community context. Regardless of the tools used, assessment from a resiliency-based framework is or­ ganized around the following questions that reflect a risk and protective factors' per­ spective as appraised by the family members.

• What are the sources of distress in the lives offamily members? (risk factors) • How do family members view these issues? (appraisal) • What aspects within the family and their extended world contribute to these

sources of distress? ( risk factors) • Are there additional factors that contribute to this distress? ( additive factors) • What are the resources for coping and support possessed by family members,

the family as an organization, and their external world? (protective factors) • How can family members use these resources? ( access to resources) • How can these resources be enhanced? (strengthening ofresources) • What barriers are preventing family members from using these resources?

(barriers to resources) • How can these barriers be reduced? ( strengthening access to resources)

The information used to answer these questions can come from information obtained from the family, other relevant sources ( e.g., school, referring agency), and the counselor's understanding of the community and the broader context.

While assessment occurs at the beginning ofwork with families, it also required throughout the entire process. New information can emerge as the social worker gains the trust of the family members. As indicated in the previous vignettes, life circumstances of families can change due to circumstances within a family's ex­ tended circle as well as the larger community context. As a result, social workers need to be responsive to these changes and reflect these changes in their profes­ sional judgment regarding the appropriate intervention strategies.

Based on the recommendation of Fraser and Galinsky ( 2004) and Chazin, Kaplan, and Terio ( 2000), the following skills and principles are important in using a resiliency model in the assessment process:

1. Assess the risk and protective factors present within the family, the community, and the larger social context.

2. Demonstrate respect for the clients as possessing strengths and potential re­ sources; listen for their survival strategies.

3. Help clients recognize their strengths.

68 I N T R O D U C T I O N T O R E S I L I E N C Y – B A S E D P R A C T I C E

4. Engage the family members as partners in the assessment process. 5. Identify the risk and protective factors that can be changed. 6. Engage the family in the selection of the interventions. 7. Be knowledgeable about practice interventions that can address the risk factors

and support their protective factors.

Fraser and Galinsky ( 2004) stressed the importance ofpractitioners identifying keystone risk factors-the family and social conditions that are important causal factors and can be changed through an intervention. Identifying factors that are both causal and subject to change enables the social worker and the family to ad­ dress the problem in an effective manner. Families bring to counseling sessions a variety ofproblems. One important task is to help family members identify where we can begin. What are the areas that are amenable to change and ifchanged would have an important impact on the family (and frequently on some of the other problems as well)? For example, in the Rogers family (in chapter 1), where the chil­ dren both blamed themselves for the family's financial problem, the parents helping the children gain a more accurate understanding of the cause of the family's finan­ cial problems was an important and doable first step. For the Lo family, helping the parents understand that their daughter's suicide attempt would not lead to their being deported was also important and doable. The concept ofkeystone risk factors can be helpful in answering this question. Efforts directed toward these factors can help create additional positive change because positive changes reverberate throughout the family system and thus encourage families to believe that they can make a difference. As F. Walsh stressed (2006, 2016), it is important to think in terms ofmastering the possible, not only because it can create change but also be­ cause such effectiveness enhances self-efficacy and hope for the future.

Assessment Tools

Assessment tools have been developed to help understand the current functioning of the family unit. Several of these are relatively narrow in focus, like the behavior of the children or the nature ofconflict within the family, while others provide a wider picture ofthe functioning within the family. Although a list is provided in the mate­ rial that follows, the emphasis in this discussion is on the interview process and the use ofmeasures, like the genogram and ecomap, that involve an active collaboration between the counselor and the fainily members.

Measurement Instruments

Some of these measures look at the wide range of family functioning, and others target more specific aspects of the family. The list of instruments that follows are

69 Assessment of Families

designed to look at a wide range offamily functioning first and then those that target more specific areas.

The following three measures evaluate a wide range offamily functioning:

The Self-Report Family Inventory (SFI), developed by Beavers and Hampson (1990), measures family functioning. It has been used with families from a wide range ofsocioeconomic groups (Thomlison, 2004 ).

The Multi-Problem Screening Inventory (MPSI) (Hudson & McMurtry,

1997) assesses family relationship problems, marital satisfaction, partner abuse, personal stress, and partner or child problems (Hudson & McMurtry, 1997).

The McMaster Family Assessment Device (FAD) (Epstein, Baldwin, & Bishop, 1983) measures six areas of family functioning: problem-solving; communication ( verbal communication in terms of instrumental, affective,

clear or masked, direct or indirect); roles; affective responsiveness; affective involvement; and behavior control. These dimensions are relevant to a

resiliency perspective. The information obtained from this instrument can be used to identify transactional patterns within the family. Whether specific patterns are dysfunctional or adaptive is determined by the larger context of what emerges as helpful for the individual family in this setting (J. Miller, Kabacoff, Bishop, Epstein, & Keitner, 1994; J. Miller, Ryan, Keitner, Bishop,

& Epstein, 1999).

The two measures discussed next evaluate specific dimensions. McCubbin and colleagues have developed instruments designed to assess dimensions of families. These scales are based on their theoretical work on family coping discussed in chapter 2.

The Family Crisis Oriented Personal Evaluation Scale, developed by Hamilton

McCubbin, David Olson, and Andrea Larsen, looks at family problem­

solving strategies. It includes 30 items ofdifferent problem-solving strategies. There are also French and Hebrew versions of the scale (H. I. McCubbin, Thompson, & McCubbin, 1996).

The Family Coping Index, developed by Hamilton McCubbin, Ann Thompson, and Kelly Elver, examines how families cope with difficult life circumstances.

It includes 24 possible coping strategies (H. I. McCubbin et al., 1996).

Visual Devices

The ecomap and genogram are two visual tools used widely in assessment with families. They are useful in identifying patterns within the family and the family's relationships to the larger environment. These tools provide mechanisms by which

70 INTRODUCTION TO RESILIENCY-BASED PRACTICE

the family counselor and the family can collaborate to identify sources of strain and distress and important resources for the family.

The ecomap is a visual representation of the family's transactions with the wider environment. These transactions include those ofindividual family members as well as the family as a unit. Families can be asked to map their relationships with impor­ tant aspects oftheir external world. Some ofthe important dimensions that are typ­

ically included are schools (for families with school-age children), extended family members, employment, health systems, and other social services that are part ofthe family life. Families can be encouraged to identify other entities that are relevant to their family life ( e.g., the church and local recreation program). Arrows and lines are then used to describe the flow of energy from family members to aspects of the en­ vironment. Arrows describe direction, and the width ofthe line indicates the degree of energy involved. Conflictual transactions can be delineated by cross-hatching. 1his set of lines thus conveys to the family sources of support as well as possible exhaustion and tensions.

The ecomap has the advantage of making visible the sources of support ( ex­ ternal resources) and strains within the family in terms of its transactions with the wider world. While people often experience distress or feel nourished by other interactions, seeing such patterns on paper can be quite powerful in identifying the nature of them in their lives. From a resiliency perspective, creation of the ecomap sets the stage for discussion about what might possibly be done to reduce the stresses and to enhance the resources in ways that can promote the resiliency of the family. Ihe Kastorfamily consists ofMr. and Mrs. Kastor, their 7-year-old son, Jack, and 5-year­ old son, Chad. Ihe family receives supportfrom agrandparent, who helps take care ofthe children when they are ill and cannot attend day care. Their 7-year-old son, Jack, has been having difficulty in school, and the parents dread calls from the teacher. Ihe parents have been pillars oftheir temple for many years. They feel valued in this setting and experience their relationships with fellow temple members as their main support system. Mr. Kastor is concerned about the stability ofhis job because there have been layoffs, and people are worried about who will be next. As a result, there is pressure on everyone to work extra hours to prove their worth to the company so that they can escape the next round of layoffs. Mrs. Kastor isfeeling satisfied with her employment situation. Their son Chad has some serious health problems, and the parents have had problems in getti

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