Case Example of Family Assessment
The Jeddi family is a real family in a real situation. They
came to the attention of the nurse when the family was referred
to the county home health agency for a baseline
family assessment with their impending adoption of a 4year-old boy from Russia. This upper middle class Caucasian
family consists of Ben (age 51), Mare (age 43), and
the son they will adopt, Alex (age 4). See Figure I-1 for the
Jeddi family genogram and Figure I-2 for the Jeddi family
ecomap.
Ben and Mare have been married for 8 years. Ben has a
PhD in chemical engineering and does consulting work.
His business is located in the caretaker apartment located
in the basement of their home. Mare has a PhD, is a pediatric
nurse, and teaches at a private university. They are
adopting a 4-year-old boy from Russia. Mare has a diagnosis
of infertility after 2 years of trying to have a biologic
child and extensive testing. The infertility issue was a significant
loss for both Ben and Mare. The couple considered
in vitro fertilization. Mare decided against this approach
because she felt the risks of failure of pregnancy
and miscarriage were too great. Ben felt that this was
Mare’s decision to make as it more directly involved her
physical and mental health. He supported Mare’s decision
to not pursue in vitro fertilization.
Mare initiated the discussions about adoption. The decision
to adopt a child was reached in May of this year after
a year and a half of discussion and investigation. Initially,
Ben was not equally committed to the concept of
adoption and had a longer grieving process over their inability
to have a child together than Mare. The issue of biologic
heritage and the loss of blood lineage were more significant
to Ben. The significant issue for Mare was the loss
of being parent and raising a child.
The couple investigated several adoption agencies and
attended potential adoptive parent classes a year and a half
ago. At that time, Ben was not ready to make a commitment
to adoption. The topic of adoption repeatedly was
discussed by the couple over the course of the next year.
In January 1994, the couple again seriously considered
adoption. Mare investigated several adoption agencies
72 years
Resp. failure
Jeddi family
80 years
Alzheimer’s
Kyptosis
Institutionalized
Ben
(51)
Engineer
Overweight
Hypertension
High cholesterol
Tom
(4)
,5% height and weight
Speaks only Russian
Orphan since 3 months
Overweight
Hypertension
Emphysema
@ 4 years of age
Oct. 1994
62 years
Lymphoma
Sepsis
M 1986
Generation 1
Date
Family name
Completed by
Generation 2
Generation 3
Mare
(43)
Nurse
Obese
Infertility
Mare
(43)
Tom
(4)
Adoption
service in
Arkansas
Sister
Friends
Band
Orphanage
in
Russia
Friends
Social
group
Local
adoption
service
Ben
(51)
Mother Work
Strong
Tenuous
Stressful
Energy flow
Key
FIG. I.1
FIG. I.2
again, as she was not satisfied with the one they selected
the last time. A local adoption agency was found to be
supportive and informative for them. The couple attended
an information meeting. After much intense emotional
discussion, the couple pursued more information about
adoption with the support personnel from the agency. At
the end of May, Ben and Mare decided they wanted to
adopt a child and completed the application process.
Both Ben and Mare feel this was an emotional time for
them. After they made their decision to adopt, the next
steps were to decide from which country they wanted to
adopt a child, the child’s age, and which child. They decided
that, given their lifestyles and personalities, they
wanted to adopt an older child between 3 and 5 years of age
and not an infant. Ben wanted to adopt a son. Mare was
not selective of the gender. Ben felt that the issue of race
was important to him. He felt that he might have difficulty
bonding with a child of dark skin as his own family. Because
of Ben’s immediate family origins from Finland, they
decided to adopt a child from eastern Europe. Russia was
selected because of its historical ties with Finland.
Mare reviewed videotapes of 40 children and selected
the top male children for them to select from. Mare is a pediatric
nurse and was determined to be the one to make
the decisions about health. After viewing the films numerous
times and reviewing a medical examination, Alex was
the young child of choice. Ben and Mare made a formal
petition to adopt Alex.
The process has taken 6 months. They are currently
waiting for the final paperwork to arrive from the Russia
government, which is expected in the next few days. They
are in the midst of preparing their home for the arrival of
Alex. They will both travel to Russia in 2 weeks to pick him
up, complete the formal adoption process in Russia, and
travel home together as a new family.
They are nervous and excited about the adoption. They
are concerned about how Alex will adjust to them and the
move to America. They are concerned about how adopting
a 4-year-old will change their lifestyle. The preparation of
their home for the arrival of Alex has been time consuming.
The arrangements for travel to Russia are being finalized.
Ben has taken 2 years of Russian 20 years ago; both
are currently taking individual language tutoring in Russian.
Ben and Mare are currently working full time. Mare
plans to continue working full time after they adopt Alex,
but she does have a reduced workload for the next 4
months. They plan to have Alex attend full-time preschool.
The initial assessment of the Jeddi family involved the
use of two assessment approaches with their respective instruments,
guidelines, a genogram, and an ecomap. A summary
of the findings from this assessment follows.
FAMILY SYSTEMS STRESSOR STRENGTH
INVENTORY
The FS3I is presented, which focused on the Jeddi family
stressors and strengths to create a plan of action. Ben and
Mare were interviewed together in their home by the
nurse. Each person completed the FS3I, which provided individual
and composite scores. Figure I-1 presents a completed
genogram. Figure I-2 shows the Jeddi family
ecomap. Figure I-3 and I-4 provide the scoring for the
quantitative summary of stressors and strengths. A qualitative
summary (Fig. I-5) presents a brief picture of the
family stresses and strengths and served as the guide for
the family care plan (Fig. I-6).
The general stressors of the family were the impending
adoption of Alex, issues of family nutrition and dieting,
and lowered self-image for both Ben and Mare. Mare was
found to have a higher general stress level than Ben. She
states that in addition to the above stressors she is concerned
about: stress relative to housekeeping issues, an ongoing
physical problem with her knee, and guilt for not accomplishing
more than she presently is able. Ben noted
that issues related to his mother, who has Alzheimer’s disease
and lives in an assisted living center, causes him additional
stress. The nurse rated their general and specific
stressors higher than both Ben and Mare rated themselves.
The specific stressor identified by Ben that is causing
him the most stress is the impending adoption of Alex. He
is concerned about time management with work and a new
family member. The additional stress of his mother’s care
is requiring a lot of his time. She is well taken care of in an
assisted living center, but he is concerned about her advancing
Case Example of Family Assessment
dementia. At present he is actively involved in
renting out his mother’s home. The specific stressor identified
by Mare was how she is going to manage food preparations
and meal times after they adopt Alex. She stated
that cooking and meal preparation are currently a big
problem for her. Mare stated that Ben does not help with
food preparation or clean up now. They both eat on different
schedules. She is concerned about family dinners
and feels this is an important time for them with Alex.
Food preparation is not a new issue for them. She stated
that she feels pressured and “like a failure” because she
does not manage this aspect of their family life well now,
before the addition of Alex. In the past the family has
hired a cook which was a “excellent solution” for them.
The have been without a cook for 2 years now after their
previous cook moved out of state.
The strengths of this family are many. They scored their
individual strengths inventory almost identically, which
demonstrates a similar perception of their family unit. Both
Ben and Mare viewed their family and each other as experienced
problem solvers. They have good, open communication
between them and feel that the adoption of Alex has
even brought them closer together. They recognized that
much of their current stress is related to the unknown
about Alex. They feel that once they meet Alex that they
will be able to work together to solve their problems.
The nurse concluded that this family has the strengths
they need to adapt to their new family life cycle of a family
with a preschooler.