Biopsychosocial Case

1. Source of Referral

* Who referred this family (name of person/ agency or other source)

2. Presenting Problem

* You decide what this would likely be, based on the family's situation

* Briefly describe the presenting problem

3. Family Constellation

* Give brief, capsule description of each family member to introduce them

* Include names and ages of all members of the immediate family (deceased and absent)

4. Socio-economic and Cultural Factors

* Who holds employment in this family, and at what?

* What is their race, religion and/or ethnicity?

* Are there cultural factors?

* What is their socio-economic (social class) level?

* Accommodation/Housing

* Community context

* What social support systems does the family have access to?

* What economic and/or social resources do they appear to lack?

5. Mental and physical health

* Are there any mental health problems in this family? Briefly describe.

* Are there any physical health problems or disabilities? Briefly describe.

* Any significant family history of mental or physical health problems?

* Is there evidence of AOD problems or other addictions?

* Are there any indicators of physical or sexual abuse?

6. Family Structure and Dynamics (The 12 Dimensions)

Use the following dimensions (Hepworth, Rooney and Larsen)

to describe the family structure and key dynamics that you have observed:

* Outer boundaries of family system

* Internal boundaries and family sub-systems

* Overt (spoken) and Covert (unspoken) family rules

* Family power structure

* Family