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Problem
The Perez family is composed of two parents, David (age 32) and Alma (age 31), and three children: Nora (age 10), Theodore (age 4), and Paul (male), (age 3). They are a lower middle-class, Hispanic family living in a rural community approximately one hour away from a children's hospital. David has two jobs and works every weekend to provide extra income to pay for medical expenses. Although Alma was previously employed, she quit her job with the arrival of their third child because she made less than the cost of day care. The family's annual income is approximately $39,000. Although they have health insurance, there is no option of changing jobs or relocating because they fear their healthcare needs may not be covered by a different insurance company. In addition to the $400 per month insurance premiums, the family makes co-payments of approximately $400 per month. The family has just learned about the CHIP program but has not yet enrolled. David's family lives in Mexico and Alma's family lives in various parts of the U.S. The extended family does not seem to understand the financial and health care problems facing this family. Alma was 7 months pregnant with Paul (the third child) and confined to bed when Nora first became ill. The initial signs occurred after a weekend camping trip with David and Theodore. Six year old Nora wakened with her left knee swollen and hot. Alma thought Nora had received a tick bite and kept her home from school that day. Because her knee looked better and was less swollen the next morning, she sent Nora to school and planned to take her to the pediatrician that afternoon. When Alma picked her up at school, Nora's left knee and thigh were both swollen and painful, and she had a fever. Marie could not understand why the school had not telephoned to inform her of the change in her daughter's health. It took about a year before the Perez family was satisfied with the health care Nora was receiving. However, this was not before they had changed pediatricians several times and fought with the insurance company to receive care from a variety of specialists: an orthopedist, an adult rheumatologist, a pediatric rheumatologist and a pediatric infectious disease specialist. Currently the family is receiving health care services and case management from the pediatric ambulatory care center at the children's hospital. It has been recommended that the Perez family consider applying for the CHIP program to provide healthcare for their children.
Task
A. Identify 2-3 goals for this family. Identify the importance.
B. Develop 2-3 interventions to assis this family. How would you evaluate the effectiveness of these interventions?
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