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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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the lees vitals
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

the lees strengths
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

the lees weaknesses
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

interactions with external systems
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
interactions with external systems1
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

multilevel family practice model
Multilevel Family Practice Model
  • How family system is related to other institutions
  • Incorporates social worker’s role in social justice – intervene in systems to make changes
  • Assessments
    • Household income/expense report
    • FABR chart
    • Home visit & neighborhood walk
    • Geographic data map

Hutchison, 2008, p. 361-365

abcx model of family stress and coping
ABCX model of family stress and coping
  • ABCX
    • A-event in family system
    • X-becomes a crisis
    • B-understand family’s resources (internal and external) key to outcomes
    • C- understand family’s definitions of event
  • Double ABCX
    • Over time crises deplete family’s resources
    • Results in negative outcomes (e.g., Nao Kao tried to run out of hospital with Lia)

Hutchison, 2008, p. 360-361

multilevel abcx interventions
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 understanding of Lia’s problems and treatment
multilevel abcx interventions1
Multilevel & ABCX interventions
  • Improve services through MCMC
    • Provide professional interpreter for communication
    • Start at the beginning to explain disease and treatment
    • Doctors anticipate “big one” and should explain that to family
    • Education must respect family’s belief system
multilevel abcx interventions2
Multilevel & ABCX interventions
  • Child Welfare
    • Wrap services around family
      • Nutrition education
      • Parenting for children with disabilities
      • School for Lia
    • Focus on understanding
      • Know family’s cultural framework
      • Explain procedures
      • Ensure that family comprehends what they are being told and what is happening

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