Refer back to the interview and evaluation you conducted in the Topic 2 Family Health Assessment assignment. Identify the social determinates of health (SDOH) contributing to the family’s health status. In a 750-1,000-word paper, create a plan of action to incorporate health promotion strategies for this family. Include the following:

1. Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
2. Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions.
3. Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
4. Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.

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Solution

Family Assessment Part II

There are five Social Determinants of Health (SDOH) that impact and influence a family, their health choices, health access, and their view of caring for themselves. The first, economic stability, influences the area where a person lives, availability of employment, grocery stores, and educational opportunities. The second, access to and level of education, influences employability, understanding of health and health needs. Next, social and community context are influences within in the area a person lives, the people they identify and socialize with, and their interaction with the community as a whole. Health and health care are the health clinics, primary care physicians, and hospitals that are of easy access to the person and their family. This does take in to account the person/family’s health literacy. The last SDOH, neighborhood and built environment, accounts for the available housing and housing conditions, environmental conditions, crime and violence within the person’s neighborhood, and access to markets with healthy food choices(SDOH, 2018). It is very easy to see how each of the social determinants affects and influences the others.  This paper will discuss the influence the social determinants of health have on this family, the health model that would best support this family’s health concerns, and the strategies to support this family’s move to overall health promotion.

 SDOH Impact on Family Health Status

This family lives in a good neighborhood, with strong academic schools, ready access to health care, a support system made up of friends and family, and markets close by that offer [cmppp_restricted]healthy food choices. The children routinely see their physician and dentist. A concern is the mother’s inability to afford health insurance at this time, and the out-of-pocket cost of health care is prohibitive to her income. She is self-employed and is currently able to keep up with daily expenses, however, without any financial support from the children’s father, this is becoming increasing more difficult. The mother is putting off taking care of her diastasis recti which is frequently symptomatic, but she has learned how to help herself when this problem does become symptomatic. More concerning is the abuse suffered by the mother and witnessed and suffered by the children.   The emotional, mental, and physical toll this has taken is still not fully understood. The mother has shared this information with her physician and the physician of the children.  Suggestions for counseling have been made, however, there are road blocks to this. The father of the children will need to give his consent for them to seek counseling and has refused to consent. The mother cannot afford this without insurance for either herself or her children.  There are detachment concerns between the children and their father, the daughter refers to him as “him or he”, and the son refers to him by his first name. The daughter does act out when she does not get her way, in much the same manner as her father. The son is helpful and compliant with the house rules. He is quiet and supportive, taking on some chores that were completed by his father when he lived there.  He tends to internalize his emotions.

Age Appropriate Screening Tools

This situation is difficult as there is not an overt physical concern to address.  The screening tools that should be used need to reflect the desire to assess each member’s behavioral and emotional response to the abuse sustained. The screener will need to assess each person’s ability and desire to answer the questions honestly, or at all. Open-ended questions will allow each family member to answer, with the screener listening to words and inflections, watching the body language, facial expressions and interactions between family members, as each person speaks. With a sensitive subject like abuse, individual screening may allow for more open dialogue between screener and subject, especially if any one of the family members perceives their answers or questions may hurt the others. The screener will need to be aware of the educational level of each child, allowing them to ask clarifying questions, and putting questions in terms they would understand. The same care should be taken when interviewing the mother, understanding there may be areas/questions they are not comfortable answering.

Health Model and Plan of Action

As cited by Falkner, health begins where you live, learn, work, and play.(Falkner, 2018)

With this family, the use of the Socio-Ecological Model would be appropriate. In this model the individual’s behavior is influenced by factors outside of the family, and the individual’s behavior also influences these factors, according to Vicki Simpson.(Simpson, 2015) These factors include friends, extended family, the workplace, the community, and society. (Falkner, 2018)The plan will need to include the family’s perception of any stigma with being victims of domestic violence, as well as the community’s and society’s view. Friends and family seem to be supportive and have rallied around this family. Their support will be necessary for this family to heal from the assault to their mental and physical health. Seeking out support groups for the mother and children would be key. This would allow them to identify with and to be able to express themselves to others who would intimately understand what they have been through. Support groups are “safe” and allow expression of feelings, frustration, and goals, within certain rules and parameters. Another option to seek would be individual and/or family counseling. Working with a counselor, who understands the complexities of domestic violence and the aftermath, the individual/family can develop tools for coping during required interactions with the father, stresses at work or school, and learn to foster healthy interpersonal relationships.

References

Falkner, A. (2018). Health promotion in nursing care. In Health promotion: Health & wellness across the continuum (pp. 1-45). Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-and-wellness-across-the-continuum/v1.1/#/chapter/2

Simpson, V. (2015).Models and theories to support health behavior intervention and program planning. Retrieved from https://extension.purdue.edu/extmedia/HHS/HHS-792-W.pdf

Social determinants of health (SDOH). (2018). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health [/cmppp_restricted]