Case Study: Exploration And Critical Assessment Of Family Centeredness

The purpose of this case study is to explore and critically assess family centredness by means of a complex family and their practitioner. Family centred practice is an approach to intervention which targets support and strengthens parents’ capabilities to nurture and improve a child’s development (Dunst, 1997). When families are supported via a positive relationship, Bronfenbrenner (1992) says parents develop knowledge and skills, they have time and energy and are better placed in overcoming adversity. In practical terms, a family-centred approach acknowledges the family’s role in developing the physical and emotional well-being of individual family members (Bronfenbrenner, 1979). Family systems theory is an important aspect imbedded in this case study. This theory, based in human behaviour characterizes the family as a whole system. Family participants interconnect, influencing each other’s behaviour rather than an individual part (Bowen, 1974).

This case study will pose the question did the practitioners relationship benefit the Lopez family’s outcomes. It will review the features and significance of family centred practice, embedded in a family systems theory.

Introduction

This case study discusses the Lopez family, who present at risk as a result of systemic barriers. These are; intergenerational poverty, poor social housing conditions in a crime ridden district, limited access to education and unemployment. These barriers are highlighted by health-related conditions (HIV, AIDS, cancer), emotional well-being, drug and alcohol misuse, incarceration and domestic violence. Both immediate and extended family have been emotionally, psychologically and physiologically impacted due to the chaotic nature of their family (Best & Lambie, 2016). Mr Lopez sold drugs for a living and is a life member of a street gang. He has been diagnosed with AIDS. Mrs Lopez has been the victim of extreme physical abuse due to Mr Lopez’s drinking and she has recently undergone chemo therapy for stomach cancer. Manny Lopez (14years) has been placed by the court into a residential treatment facility for selling marijuana whilst under the influence of alcohol. Manny’s sister lives with her boyfriend and his older brother resides with his aunt (court appointed guardian).The family has no transport or social or family support. Mr and Mrs Lopez were apprehensive when home-based services were offered. Best and Lambie (2016) believe this is not because they don’t wish to engage but instead scared.

Genogram

The genogram is a graphic representation (Appendices 1) stemming from family systems theory (Bowen, 1978). It depicts the Lopez family structure including three generations, providing a snapshot of information. The genogram shows members and events that have played a significant role in the family, exposing the big picture ( Hartman,1978). It provides a summary of the family’s circumstances such as limited family support on Mr Lopez’s side and repetitive patterns including multigenerational substance abuse and long-term gang involvement. What happened in one generation, happened in another. These patterns provide the practitioner and family with important clues for linking the past, present and future, allowing the family to move on.

Family Centred Practice

Traditionally families offer socialization, safety and security. They furnish shared meaning, identity and self- worth. Assisting the Lopez family to find solutions and develop strategies, the practitioner has taken a family centred approach, recognising that the family is an important source that can influence the wellbeing of individual family members (Dunst, 1997). By taking a participatory family centred approach the practitioner was collaborative, making connections, setting goals, providing choice and encouraging the family to take action. Mr and Mrs Lopez determined that they wanted to become better parents discussing with the practitioner ways to progress forward. Mrs Lopez identified the intrusion of outside systems and agencies indicating multisystem fatigue. Their professionally centred approach adopts inadequate consultation and coordination. In contrast, the practitioner was responsive in understanding the family’s issues, adapting to meeting the needs of the family by coordinating emotional, financial and medical services. She built a positive, trusting relationship with the parents at their first meeting, by allowing them to have an active say in the decision-making process. The practitioner had their best interests at heart and she showed an active caring response. She provided nurturing alliance (Mackay, 1996) and became a transitional secure attachment figure (Best & Lambie, 2016). The practitioner promoted family centre practices by normalizing patterns of living, assisting the Lopez’s to set boundaries for Manny, teaching them to cook and shop. This relationship helped the Lopez family develop a sense of agency, commitment and involvement in their own care, crucial to developing effective engagement.

Family Systems Theory

When pondering theories within a family centred practice, a systems theory approach can be considered. A systems theory provides understanding of the relationships between people. It gives a complete view and informs a family centred approach (Bertalanffy,1968). A family systems theory recognises the child as part of a family system, where members are interdependent making the Lopez family functions collective (Dunst, 1997). The Lopez family had open physical boundaries, all doing their own thing with no rules. Manny could come and go as he pleased. The family issues were intrinsically connected such as the action of Mr Lopez and his drug and gang involvement influenced Mrs Lopez into taking drugs and prejudiced Manny as he was ‘born’ into the gang and began selling drugs at age 9. The action of one member such as the abuse of Mrs Lopez as a child, her underdeveloped secure emotional attachment and drug use, impacted her ability to parent. Described as a “lousy parent” affected another, subsequently impacting Manny and his siblings. Collectively the family was able to “get things of their chest” and voice their anger by each having a say. The family became more organised and better able to cope with daily stress. Walker (2019) says this multi system approach assisted individual and collect members of the family by increasing their closeness, providing support to each other as well as Mr Lopez’s health.

We could also consider a multigenerational system, that considers a connection or lack of between the Lopez’s current and extended family. The family system affects who they are, how they think and communicate (verbal and nonverbal). Family choice and decision making occurs at all levels of family involvement in the intervention process and the extended family such as the grandparents, aunt and uncle became a great support, providing nurturance and important resources such as care and employment (Family Systems Theory, 2017, p6). These two theories explain how family’s function in the real world.

Conclusion

The practitioner’s relationship with the Lopez family was respectful, honouring the family’s autonomy (Turnbull et al, 2006). Family systems theory observes families as a whole, with each part depending on the other, whilst fostering a family centred approach ensured family choice with an emphasis on solutions rather than problems. The combination of family systems theory and family centred practices enabled the practitioner to build a relationship which directly impacted the Lopez family’s outcomes in a positive way.