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aDDressing family needs through the Multilevel Family Practice Model

aDDressing family needs through the Multilevel Family Practice Model. The Lee Family. The Lees – vitals. Primary Characters Nao Kao, father Koua , mother Lia, daughter Location From refugee camp in Thailand Settled in Merced, CA, in the San Joaquin Valley (Central CA)

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aDDressing family needs through the Multilevel Family Practice Model

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  1. aDDressing family needs through the Multilevel Family Practice Model The Lee Family

  2. The Lees – vitals • Primary Characters • Nao Kao, father • Koua, mother • Lia, daughter • Location • From refugee camp in Thailand • Settled in Merced, CA, in the San Joaquin Valley (Central CA) • Predominantly immigrant neighborhood, changing from Hispanic to Hmong • 41.36% Latino (Lee & Pfeifer, 2006) • 12.37% Asian, mostly Hmong (Lee & Pfeifer, 2006) Fadiman, 1997

  3. The Lees – strengths • Function well as a unit within their system of established roles and rules • Love for each other and stability of family system has sustained them through great trials • Extended community of Hmong – Merced neighborhood, clan system, • Strong and deeply rooted beliefs of the world and events • Welfare dollars last throughout the month - financial needs are not a problem Fadiman, 1997

  4. The Lees – weaknesses • No discipline or limits for Lia leads to behavioral issues outside of home • Being overweight hinders Lia’s care in emergencies • Affect on Yer of being blamed for slamming the door • Language barriers for family interaction within government and health systems • Cultural barriers impede understanding of responsibilities (e.g., medicine dosage) • Face discrimination due to race, language, culture, class Fadiman, 1997

  5. Interactions with external systems • Merced Community Medical Center • No professional interpreters offered to Lees • Unethical practice by health professionals of having family sign documents incorrectly indicating that they understood symptoms and acknowledged treatments • Family had fundamental misunderstanding of how prescribed medication works (i.e., because one keeps taking it) • Over several years, Lees still had little understanding of epilepsy and treatment • Physician filed CPS petition

  6. Interactions with external systems • Child Welfare System • No professional interpreters offered during screening or trial to help family • Personal reports (doctors, Dee, Jeanine) say parents are good caregivers • Jeanine Hilt, CPS social worker, visited the home, understood fears and anger, empathized with family • Dee, foster mother, very supportive of Lees and cared for Lia’s needs and violent outbursts Fadiman, 1997

  7. Multilevel Family Practice Model • How family system is related to other institutions • Lees have strong extended family/clan • Lees have poor relationship with larger community and institutions • Incorporates social worker’s role in social justice – intervene in systems to make changes • Understand how systems interact with and perceive Hmong families • Assessments • Household income/expense report • FABR chart • Home visit & neighborhood walk • Geographic data map Hutchison, 2008, p. 361-365

  8. ABCX model of family stress and coping • ABCX • A-event in family system (Lia’s epilepsy) • X-becomes a crisis (seizure that won’t stop) • B-understand family’s resources - internal and external – as the key to outcomes (strong kinship bonds and beliefs) • C- understand family’s definitions of event (hospital made Lia sicker, medicine makes her sick) • Double ABCX • Over time crises deplete family’s resources • Results in negative outcomes (Nao Kao tried to run out of hospital with Lia because of the way doctors referred to death) Hutchison, 2008, p. 360-361

  9. Multilevel & ABCX interventions • Find the full story • Neighborhood walk – cow’s head on the stoop; animal sacrifices • Home visit – food, family, handicrafts, rituals, history • Family’s definition of Lia’s problems and treatment • Reframe family’s understanding of western medicine and medical community

  10. Multilevel & ABCX interventions • Improve services through MCMC • Provide professional interpreter for communication • Start at the beginning to explain clearly disease and treatment to the family • Doctors anticipate “big one” and should explain that to family • Education must respect family’s belief system • Reframe medical professionals’ definition of family

  11. Multilevel & ABCX interventions • Child Welfare • Wrap services around family • Nutrition education • Parenting for children with disabilities • School for Lia • Support group for Hmong with special health needs • Focus on understanding • Know family’s cultural framework • Explain procedures • Ensure that family comprehends what they are being told and what is happening • Training on Hmong for child welfare staff

  12. references Fadiman, A. (1997). The spirit catches you and you fall down. New York: Farrar, Strauss, Giroux. Hutchison, E. D. (2008). Dimensions of human behavior: Person and environment. Thousand Oaks, CA: Sage. Lee, T. P., & Pfeifer, M. E. (2006). Building bridges: Teaching about the Hmong in our communities. Saint Paul, MN: Hmong Cultural and Resource Center. Retrieved October 25, 2008 from http://www.hmongnet.org/

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