Understanding the Biopsychosocial Assessment Format

Name- Tom Banks and Jenny Banks

Reason for referral- Tom has been found to ask for assistance for electricity and gas, and for food vouchers, for the second consecutive week in a row. Although Tom has been provided help by the worker, he has been influenced to agree to seek additional help for resolving all major family issues.

Information was obtained through phone calls that were conducted on 27^th and 28^th of October, followed by a home visit on the 29^th of October. Tom and his wife Jenny provided the necessary information for the assignment. In addition, phone calls with the primary school principal, and a woman at the supermarket who lived across the road on 31^st October, and with Dr. Jones on 7^th November, helped in retrieving necessary information for the biopsychosocial assessment. A visit was also scheduled with the minister Allan Parson on the 8^th of November.

Orientation to Tom- During the home visit, Tom portrayed an unwelcoming attitude and let me in his house. The house appeared in need of a paint. The yard and garden were well kept and tidy. Tom clearly mentioned about his disapproval regarding the welfare service. However, he also said that it was not his intent to disrespect me. He was also confused as to why should he and his family seek help when they have done right things all throughout their life. He also demonstrated irritation about the fact that his wife stopped feeding, looking after herself and caring for the kids, upon learning of the Down’s syndrome. Tom displayed labile affect where there was a clear demonstration of emotional incontinence against his wife and children. This resulted in irritation regarding the house visit for the community welfare service. He also expressed displeasure for Jenny’s family by stating that her parents would take over the family matters if Tom allowed them to interfere. He was also not trustful of others and expressed discontent on his distant relationship with his folks.

Orientation to Jenny- Jenny adopted a welcoming approach in spite of being tired that morning. Jenny manifested persistent low mood and lost all interest in self-care or care for her kids. She even stopped feeding her children. She realised that she sounded like a selfish when she stated about her want for a normal child, like others. Her gestures and facial expression also suggested that she had grown tired of her responsibilities and had also been depressed, following the doctor’s diagnosis of Down’s syndrome. However, she was still hopeful of leading a meaningful and happy life someday, as evident from her statements. She was also afraid of Tom and the aftermath of his discovery about a talk with the GP and the minister at the church.

Identifying Pertinent Information from the ‘Banks Family’ Case Study

Tom:

Age- 36; Christian; from Albury; male; married and having two kids; poor living situation; in want of basic needs and secured housing; no support from either Jenny of Tom’s family, place of living is in mortgage; unemployed; growing dislike towards Jenny and his children; not trusting others; considered life to be pretty good before birth of Christie; abusive towards his wife.

Jenny:

Age- 35; Christian; female, married to Tom; having three kids; third child Sarah diagnosed with Down’s syndrome; poor family situation; gradually deteriorating relationship with Tom; family is supportive but cannot provide help due to Tom’s reluctance and dislike; used to work earlier; presently in a depressed state of mind; apathetic about future; might have been subjected to emotional and physical violence as reported by a woman at the supermarket who heard them arguing and a black eye on Jenny; persistent low mood; want to lead a normal life.

Tom is from Albury and belongs to a family that is self-reliant. He has 2 older brothers who currently reside in several parts of NSW. He is distant to his biological parents and hardly talks to them, due to their disapproval of Jenny’s family and their son’s place of residence. Jenny’s parents Liz and Dave, are of the local community and have been strong-minded and suspicious. They have been identified by Tom as interfering and inquisitive into the family affairs of their daughter. Tom and Jenny have two daughters Sarah (9 years) and Christie (8 months), and a son Terry (6 years). Christie has been diagnosed with Down’s syndrome.

One significant life event occurred when Tom left Albury at the age of 18 years due to his want of travelling the country. However, following diagnosis of their third child Christie with Down’s syndrome, Tom left his job and it was impossible to console Jenny. In the initial years of their marriage, Tom and Jenny shared a warm relationship, as stated by Tom. Although Tom said that he had disapproved of Jenny’s mother moving in with them after the birth of Sarah, to take care of her, Jenny occasionally met her parents at the church and went out for lunch once a week with them. However, they could not cope when they learnt that Christie was diagnosed with Down’s syndrome. Jenny fell into a heap and no longer participated in the daily activities. This made Sarah, their elder daughter perform most of the tasks, which Tom did not consider appropriate. The recent onset of events has left Tom in an annoyed state of mind and he does not quite approve of the presence of depressive symptoms in his wife.

Assessing Risk and Protective Factors

No specific information regarding separation or divorce in the family have been found. Interaction with the primary school principal and the woman at the supermarket suggests that Jenny might have been subjected to abuse by her husband. The principal stated that it can be deduced from Terry’s account that his parents fight a lot. This is consistent with statements of the woman from the neighbourhood who mentioned that she has often heard yelling, arguments from Tom’s house and also found Jenny with a black eye one day. This may indicate exposure to physical abuse. The major health issue that Jenny has been suffering from is depression.

Sarah and Terry attend the same school. However, owing to the ill health of her mother, Sarah has to most often miss her classes. On the other hand, Terry is quite fond of his mom and cries a lot. He dislikes fight between his parents and fails to show a progress in writing or reading. Thus, both Terry and Sarah show a poor level of engagement with their schooling. Terry has not developed a cordial relationship with his friends of teachers and does not trust the latter.

Tom had been working at the Council outdoor team when he met Jenny. Jenny worked at the same place in the office. They had a good job and secured life. He started working from 2004 and left it recently, after Christie’s birth. After leaving the job, they have no source of proper income and are living on the expenses of the Centrelink fund. Moreover, they are striving hard to maintain the mortgage payments and doctor bills. Thus, their current income does not meet their needs and is putting them in a financial crisis.

Jenny was active in the Church community, visited the pub, was involved with the church reading program and canteen. She also went out or lunch once a week, at a pub and played pokies for a while. She also developed a habit of spending too much cash. Tom had a desire of travelling and exploring the country.

Currently Jenny has been diagnosed with depression, which is confirmed by her physician. Although neither of them have any previous history of mental disorders. The woman at the supermarket found Jenny with a black eye one day and also heard them argue and yell. This may specify presence of an abusive relationship. His disapproval of interference in his personal life and subsequent prying of Jenny’s mother might have contributed to his abusive nature. Abusive nature of Tom increases the risks of him acting as the perpetrator and causing significant harm to his wife and children. Currently, only the depressive symptoms are being addressed by Dr. Jones.

No specific information that pertains to physical health of Tom and Jenny have been retrieved. Thus, it cannot be stated whether the current health needs are being addressed.

There is no history of illicit substance abuse, smoking or alcoholism in the family. However, Tom stated that Jenny used to play pokies, a form of gambling where she lost a considerable amount of money. Tom attempted to change this behaviour of his wife by restricting her meetings with her parents.

One incident that might have resulted in legal complications involved the neighbourhood woman observing Jenny with a black eye. The woman was about to call the police. One major issue is associated with the money that they have to pay for the mortgage on their housing.

An analysis of the case study suggests that Tom and Jenny own their own family. They donot have much contact with extended family members. Although they had been employed in previous times, current unemployment makes it difficult to pay off their mortgage loans. They are under the financial help of Centralink welfare service and the mother Jenny is severely depressed. No community supports are used by them.

Tom does not like maintaining contact with family or friends. Thus, no informal support is being utilised by the family.

Summation- The family is presently in a crisis due to recent diagnosis of Down’s syndrome in their youngest child, unemployment and financial loans.

Key concerns- Financial instability, lack of social support, depression in Jenny, medical expenses

Goals- Manage depression, provide necessary support for Christie, counsel the family to accept the child, provide financial assistance

Future hopes- Jenny will get cured of her depressive symptoms, the children will regularly attend school, Tom will resume work

Strength and support- Helping the family adopt appropriate coping skills to confront the emotional and financial crisis would help them to recover and live a purposeful life.

Barriers- Lack of cordial relationship with family and friends, reluctant and irritation in Tom, apathy in Jenny

Goals	Who will be responsible	Action	Time frame	Schedule date
Short-term	Social worker of the community based organisation	Increase the carer payment	2 months	30/06
Intermediate	Dr. Jones and an active helper	Manage Jenny’s depressive symptoms	6 months	15/07
Long-term	Down Syndrome Society	Provide an array of benefits to help in better survival of Christie	1 year	30/08