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1111 Student Name: Albert Ramen ID: 30012892 EXAMPLE OF EQUIPMENT PURCHASE PROPOSAL 2 Contents EXECUTIVE SUMMARY ................................................................................................ 3 Recommendation ............................................................................................................ 3 Problem ........................................................................................................................... 3 Benefits of the Rational Combi....................................................................................... 4 Methodology ................................................................................................................... 4 INTRODUCTION .............................................................................................................. 5 Profile .............................................................................................................................. 5 Organizational Structure Overview ................................................................................ 5 Kitchen Operations/Equipment ....................................................................................... 5 Health and Safety Report ................................................................................................ 5 Installation Plan .............................................................................................................. 6 Maintenance Plan ............................................................................................................ 6 COMPARISON/CONTRAST CHART of SELECTED COMBI MODELS ..................... 1 CONCLUSION ................................................................................................................... 1 Savings in Operation Costs ............................................................................................. 1 Customer Satisfaction ..................................................................................................... 1 Recommendations ........................................................................................................... 2 3 March 27, 2020 To: Mr. Dalton McGinty and Mr. George Smitherman From: Albert Ramen Subject: Replacement of the Cleveland Convection Oven EXECUTIVE SUMMARY Recommendation I request you approve the release of funds for the purchase of a Rational Combi CPC 61, as it will greatly benefit the facility. Provided with the Combi, our foodservice department will exceed its goals of quality assurance and fiscal responsibility. Its use will capture the facility’s strategic initiatives to deliver exceptional experiences for our residents and staff. Problem Seven Oaks Long Term Care facility, located in the heart of downtown Burlington, is a one hundred-bed resident facility and community outreach center for seniors ...

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1111 Student Name: Albert Ramen ID: 30012892 EXAMPLE OF EQUIPMENT PURCHASE PROPOSAL 2 Contents EXECUTIVE SUMMARY ............................................................................................... . 3 Recommendation ............................................................................................... ............. 3 Problem ............................................................................................... ............................ 3 Benefits of the Rational Combi..................................................................................... .. 4
Methodology ............................................................................................... .................... 4 INTRODUCTION ............................................................................................... ............... 5 Profile ............................................................................................... ............................... 5 Organizational Structure Overview ................................................................................ 5 Kitchen Operations/Equipment ....................................................................................... 5 Health and Safety Report ............................................................................................... . 5 Installation Plan ............................................................................................... ............... 6 Maintenance Plan ............................................................................................... ............. 6 COMPARISON/CONTRAST CHART of SELECTED COMBI MODELS ..................... 1 CONCLUSION ............................................................................................... .................... 1 Savings in Operation Costs ............................................................................................. 1
Customer Satisfaction ............................................................................................... ...... 1 Recommendations ............................................................................................... ............ 2 3 March 27, 2020 To: Mr. Dalton McGinty and Mr. George Smitherman From: Albert Ramen Subject: Replacement of the Cleveland Convection Oven EXECUTIVE SUMMARY Recommendation I request you approve the release of funds for the purchase of a Rational Combi
CPC 61, as it will greatly benefit the facility. Provided with the Combi, our foodservice department will exceed its goals of quality assurance and fiscal responsibility. Its use will capture the facility’s strategic initiatives to deliver exceptional experiences for our residents and staff. Problem Seven Oaks Long Term Care facility, located in the heart of downtown Burlington, is a one hundred-bed resident facility and community outreach center for seniors. Over the years it has set the standard in senior’s care in the community. It has consistently achieved its vision statement to deliver exceptional experiences for the residents and staff. The facility’s foodservice department’s mission is to exceed the standard in quality, and service, which of late it has struggled with. The main reason for not meeting the standard is aging equipment especially the seventeen-year-old convection oven. A recent audit of its performance indicates it is no longer financially feasible to operate and due for replacement because of: • Maintenance and Repairs Over the last two years there’s been a steady increase in maintenance repairs, which has resulted in an increase of twenty seven percent to the department. Numerous thermal
recalibrations and most recently the replacement of the door’s spring locking system have exceeded the budget allowances. • Operation Cost Fluctuations in the oven’s cooking and holding temperatures have caused a 12% increase in food cost due to loss and spoilage. The oven’s continuous use has measurably decreased it efficiency and power conservation by thirty percent. Based on the age and the current condition of the oven, the costs of maintenance and operation will only increase with time. 4 • Customer Satisfaction Inadequate cooking and holding temperatures have resulted in poor quality products, increased resident complaints, and revenue loss. Benefits of the Rational Combi The Rational provides measurable benefits for the operator, facility, and resident. There will be immediate short-term and long-term gains for the facility. Within two years it will deliver an increase in profit and savings to pay for its original cost. The benefits are:
• Labour Cost It will allow for a savings of .6 FTE’s per week or $ 1,460.76 dollars with an additional saving from efficient preproduction, unsupervised overnight cooking, and quick daily maintenance and service. • Food Cost It’s precise cooking technology will provide an approximate 22% percent savings in raw material and 95% in added cooking fats. • Energy Conservation the Combi’s seven different cooking modes will replace the need for multitasking and acquisition of another conventional kitchen equipment. A savings of $906.00 dollars will be gained per year in energy costs and an additional 2% per year when used continuously. • Customer Satisfaction the Combi’s seven modes of cooking applications and precise automated cooking will improve the quality and variety of food. It will minimize the chance of human error and guaranteeing the resident’s satisfaction. • Health and Safety the Combi will minimize the possibility of workplace accidents and human intervention during cooking and cleaning procedures. The automated HACCP logging system will reduce manual monitoring, recording and interpreting critical control points during cooking.
Methodology Through benchmark comparisons and contrasts with another leading manufacture’s model the Combi was evaluated for its efficiency, ease of operation, operating costs, safety features and ability to recoup its purchase price. A plan of its quick installation and in-depth training has been detailed within the report. Its installation will minimally disrupt the residents and flow of work in the facility. The ease and safety of cleaning and maintaining its performance has been encapsulated in a maintenance plan. 5 INTRODUCTION
Profile Seven Oaks Long Term Care Facility is a 100-bed facility and senior community outreach center. It is located in the heart of Burlington’s downtown residential community at the corners of Bayberry and Center Street. It is a religious non- medical health care facility accredited by the Ontario Ministry of Health and Long- Term Care. Founded in 1970, its one of Burlington’s oldest facilities caring for the elderly in the community. As an award-winning leader in long- term care its vision is to strive for excellence in the provision of care and services by meeting the needs and exceeding the expectations of its residents. Organizational Structure Overview The organizational framework of the Foodservice department is effectively organized with defined roles for each supervisor and their department. Christine Wellington, Foodservice Director and Chair of Operations is responsible for its operations. Stephen Field, Foodservice Manager is responsible for daily operations. Reporting to Stephen Field is his supervisory team of Janice Smith and Gordon Papers. Stephen Field is responsible for the daily activities of his department supervisors, six cooks and four dinning room attendants, and three sanitation maintenance staff. His key responsibility is in the coordination of food production, maintenance programs, health and safety.
Kitchen Operations/Equipment The foodservice operation is responsible for providing three daily meals for its 100 residents and 60 daily meals for its cafeteria. The cafeteria provides light meals and snacks for residents, visitors and the general public. Currently, the majority of the kitchen equipment is aged being the original equipment installed. It is maintained regularly and meets Ontario Workplace Standards. The convection oven being the central piece of equipment for all food preparation is maintained although serviced continually. Upon recommendation of the facilities Health and Safety committee it has been reported for numerous health and safety infractions. Health and Safety Report The Health and Safety committee is responsible for monitoring procedures, processes, and equipment within the facility. Due to the age and condition of the convection oven two consecutive equipment audits have been completed within the last year. The oven’s safe operation is in question due to three reported health and safety incidents within the last six months.
6 Installation Plan The removal of the existing convection oven and pending installation of the Rational Combi will be in accordance with an installation time schedule (see appendix). The existing oven is central to the ongoing business and a necessity for the daily preparation of all hot foods. Therefore, two contingency plans have been developed to address the need for the oven during installation and any prolonged delays in its installation. During installation an alternative menu plan will alleviate any demand for the use of the oven for food preparation. The alternative menu plan will be put into effect the day of and the following day if necessary. It will utilize other pieces kitchen equipment to produce a suitable menu for the residents (see appendix). In the event of a prolonged delay in installation an emergency contingency menu plan will be activated. The emergency contingency menu plan will be in place for the duration of the installation and until it’s fully operational. Power interruptions have been accounted for during installation by careful planning prior to installation. All necessary electrical work was
completed during the twelve days prior to installation. The power interruption the day of installation will be minimal with only a thirty-minute period of interruption. The interruption will take place after lunch service during off peak times for kitchen preparation. Maintenance Plan Maintenance for the Combi is streamlined and can be easily performed by trained facility staff. The required maintenance for the Combi has been divided into two distinct categories. One category represents the work to be completed by certified Rational technicians. The second category addresses maintenance to be performed by in house by trained staff. Rational staff will conduct the maintenance training the following day of installation. The required maintenance performed by Rational technicians is categorized by service faults indicated on the Combi’s display panel (see appendix). Rational customer service support center and local certified technicians are available seven days a week. A facility maintenance plan has been developed to include all necessary service to be performed by the facility’s authorized staff (see appendix). The facilities maintenance and kitchen staff is to be trained by Rational technicians during the
training session as part of the purchase plan. The maintenance plan has been divided into two categories maintenance as required and daily cleaning and maintenance. 1 COMPARISON/CONTRAST CHART of SELECTED COMBI MODELS Although the Rational ClimaPlus Combi CPC 61 and Blodgett Combi BC 14E are both electric industrial combination ovens suitable for our facility’s needs and applications, they are very different models with unique features. The following is a comparison of the two Combi models. Point of Contrast Oven Model A: Rational ClimaPlus Combi CPC 61 Oven Model B: Blodgett Combi BC-14E Exterior Construction Stainless steel top, front, and sides Stainless steel top, front, and sides
Stainless steel door, right/left hinge Stainless steel door, right hinge only Tempered viewing window Tempered viewing window Door mounted condensate trough Door mounted condensate trough Top mounted exhaust and rear external fresh air intake Side exterior exhaust and fresh air intake Interior Construction Fully welded stainless steel frame Fully welded stainless steel frame Fully insulated cooking chamber Fully insulated cooking chamber Fixed drain bottom center/back of cavity Fixed drain bottom center of cavity Self draining door drip pan Self draining door drip pan Interchangeable mobile loading rack with safety locks
Fixed loading rack Plug in door gasket Insulated door gasket Fan wheel brake double motor Two speed fan no brake or auto shut off 2 Halogen illuminated cooking cabinet Safety illuminated cooking cabinet Dimensions Width 35.1" Depth 30.43" Height 32.75" Width 31.33" Depth 34.5" Height 33" Shipping Weight Gross 560 lbs Shipping Weight Gross 680 lbs Entry Clearances Uncrated 33" Crated 42" Uncrated 34" Crated 45" Oven Clearances Right Side 2" Left side 2" Back 2" Right Side 1" Left Side 4" Back 6" Power Supply 10KW 60HZ Three Phase 208V 28amps 10KW 60HZ Three Phase 208V 50amps
Single Phase 208V 49amps Single Phase 208V 43amps Energy Conservation Delta T cooking standard feature with gradual temperature in cabinet Auto power shut off with opening off cabinet door. Auto power package available for continuous mode with power conservation. Auto power shut down in continuous use mode Maintain constant differential to current core temperature 1/2 power energy optimization system Energy reduced by 50% for 18KW to 9KW in optimization mode External Heat Source Proximity Minimum left side clearance 13.75" when there is heat source located on the left-hand side Minimum left side clearance 12.0" when there are sources of heat on the left-hand side
Minimum back side clearance 4" when there are sources of heat on the right-hand side Water Supply Range 30psi - 87psi (200-600 kPa) Range 30psi - 87psi (200-600 kPa) Must maintain 30psi minimum flow pressure Must maintain 30psi minimum flow pressure Based on quality portable water only Based on quality portable water only 3 Water treatment 6-7 ph. or higher Water treatment 7 ph or higher Water supply cold water 2" diameter steam temperature resistant Water supply hot water 2" diameter steam temperature resistant On board water heater booster and non-filter system Water heater booster and filter system optional
Water Consumption Average total water consumption 8.5 gallons per hour using combi steam option with combination heat and dry moist modes Average total water consumption 5.5 gallons per hour using combi steam option with combination heat and dry moist modes. Option is available at additional cost Values excluding usage of hand shower additional 2.0 gallons per cycle Values excluding usage of hand shower additional 2.25 gallons per cycle 3.2 gallons with dry heat and poaching feature only 2.2 gallons with dry heat and steaming feature only Ventilation Systems Steam ventilation system with automatic vapour quenching system Steam ventilation system with automatic vapour quenching system optional at additional cost Exhaust duct vented on top of unit back left/right side Exhaust duct vented on unit back left side. Clearance 4"
Non filter system with automatic descaling of ventilation Filter system with manual descaling of ventilation Cleaning Systems Online CleanJet system fully automated Automated cleaning cycle optional at additional cost Tablet detergent system WHISM compliant Liquid detergent system WHISM compliant optional at additional cost Required 50-degree Celsius average temperature rinse Required 60-degree Celsius average temperature rinse Hand shower power wash hose Spray hose for rinse cycle hot water feed nonelectrical powered Manual clean with automated cycle Manual clean cycle Descaling automated 3 settings for continuous descale cycle Descaling automated 2 settings for continuous descale cycle
4 Deliming bottle and pump assembly included Deliming bottle and pump assembly included optional at additional cost 5 settings for cleaning cabinet 3 separate programs 1 setting for cabinet cleaning cycle with auto dry Computer Technology IQT technology using probe and profile logic systems Digital readout available at additional cost 7 customized setting for roasting browning Automated descaling system with auto indicators optional at additional cost Program Library containing 8 factory settings for cooking modes Delta T cooking technology for energy conservation internal probe at additional cost. CalcDiagnosis system descaling indicator IQT sensory
technology for internal probe temperatures Delta T cooking technology for energy conservation Vario Steam technology for automated vapour quenching system IQT sensory technology for internal probe temperatures HACCP logging technology with Combi Link software Microprocessor for self cooking panel digital readouts and monitoring Vario Steam technology for automated vapour quenching system Accessories with Purchase G-N containers and grids. Chicken grids for roasting spit mode Five stainless steel wire shelves for internal cabinet locking system stationary fit
Frying baskets. Mobile oven rack with locking safety system Locking system for rack assembly Manual cleaner and hand pressure spray gun Manual cleaner and hand pressure spray gun Hinged rack for baking Stationary rack for baking Ultra vent condensation and exhaust hood Hand shower power wash hose Accessories with Purchase Exhaust hood attachment and assembly 5 Hand shower power wash hose Optional Accessories Two step door locking system Direct steam unit available. Descaling automatic feed system
Special voltage specifications with Single Phase feed Special voltage specifications with Single Phase feed Security version Security version Left hinge door Right hinge door only Mobile oven rack and loading with safety locking system Mobile oven rack and loading with safety locking system Optional Accessories Legs and castors with extension option Chicken Racks Legs and castors with extension option Interior Cabinet Capacity Six stainless steel wire shelves per seciton Five stainless steel wire shelves per seciton Maximum capacity 14 steam table pans 7 bake sheets Maximum capacity 12 steam table pans 5 bake sheets GN containers lengthwise loading 6 each 6 by 1 by 1
GN containers lengthwise loading 5 each 4 by 2 by 2 HACCP Controls Continuous output of HACCP process data via unit interface Continuous output of HACCP process data via unit interface HACCP process data is stored for 14 days output via interface HACCP automated digital processor optional at additional cost Pc/Laptop optional combi link software loaded standard feature Records only on time and temperature of each cooking mode and date of each deliming cycle. Date is accessible via RS 232 serial communications via Lab top computer or PDA Health and Safety Certification S/A - NSF - and UL certified with all parts, accessories and operation systems ETL CUS, Sanitation ETL listed and CE certified with all parts, accessories and operating systems HACCP approved logging and data monitoring
6 ISO2000 certified Oven Mobility Optional at additional cost die-cast metal casters and adjustable legs 4", 6", 25" Optional at additional cost die-cast metal casters and adjustable legs 4", 8", 24" Extended DFG- 200 model assembly kit for stacking oven Table leg 4" mount legs standard feature with purchase Table leg 4" mount legs standard feature with purchase Locking system for metal casters Locking system for metal casters Maintenance CleanJet automated cleaning system Automated cleaning system optional at additional cost DGF Zephaire EG system compliant Manual semi automated cleaning system mode Manual semi automated cleaning system mode Hand shower power wash hose Water hose with spray nozzle
Self drying mode Self drying mode Tablet detergent system WHISM compliant Liquid detergent system WHISM compliant Cleaning, deliming, and rinse cycle. Cleaning, deliming, and rinse cycle automated optional with purchase. Automated descaling cycle mode using CalcDiagnosis Automated descaling cycle mode BGF continuous flow cycle optional with purchase Automated steam flushing and steam generator descaling system steam generator descaling manual system Hand pump and spray bottle included for descaling semi automated system with auto rinse cycle Hand pump and spray bottle included for manual descaling Warranty One-year parts and labour One-year parts and labour Start up inspection service by factory authorized service agent Start up inspection service by factory authorized service agent
Operational testing and installation inspection Operational testing and installation inspection 7 Onsite training by authorized Rational Canada training experts Extended two year warranty available. Onsite programming of mode cycles by training experts Technical customer service support 7 days a week. Rational chefline technical support 5 days a week North American support
Comparison Summary of the Combi Models The Rational ClimaPlus Combi model provides exceptional benefits for the operator, facility, and resident. Rationale’s superior operating features provide optimized cost control, profit margins, safety features and resident's satisfaction. Cost Control The IQT technology precisely monitors and optimizes the cooking process to eliminate comprehensive data input such as temperature, time, and humidity. The Delta T cooking technology provides smart efficient use of energy. The microprocessor Self Cooking mode automatically detects product specific requirements and load sizes to produce consistent finished products each time. 8 Profit Return/Savings It's innovative design reduces space allocation with optimal capacity using a smaller foot print in comparison to the existing convection
oven. The IQT technology replaces the need for all other cooking appliances such as convection ovens, ranges, steamers and deep fryers. The Combi ovens efficient operation system and built in energy conservation features provide an immediate return in savings. Safety Features The Clean Jet’s innovative circulation system ensures optimal hygiene, health protection, and reduced water consumption. The patented CalcDiagnosis system automatically monitors lime scale levels and eliminates lime buildup with no need for buying or maintaining expensive water softening equipment. The automated HACCP logging continuously records critical control point information with Combi Link transferware. The automatic logging ensures health protection and eliminates timely monitoring, recording, and manual interpretation. Resident Satisfaction The digital microprocessor uses one control to provide seven different cooking modes. The different cooking modes provide limitless culinary variety. The Self Cooking technology eliminates flavour and odour transfer, even when there are different products
cooked at the same time. The nutritional value in foods is preserved ensuring the retention of vitamins and minerals. The outstanding consistency along with optimal quality cooked food will inspire the resident's confidence and satisfaction day after day. Challenges The Rational combi involves a more complex lengthy installation and training period in comparison to the other model. Although over the long term the costs for installation and training will be returned in profit savings. The operation of the Rational model is easy although it involves a more complicated lengthy training program for the kitchen staff. The intensive training program is included in the purchase. The trained will ensure its performance and maintenance is optimized. The cost of cleaning and descaling chemicals will increase budget allowances although the labour costs wil l counterbalance the offset in costs. 1 CONCLUSION Based on a benchmark comparison and contrast of features of
the two Combi models, an evaluation of installation and maintenance costs, and safety operating features, the following conclusions can be drawn. The Rational model provides measurable benefits for the operator, facility, and residents. Immediate short-term and long-term gains for the facility will be maximized in acquiring this piece of equipment as follows: Savings in Operation Costs The Combi will provide immediate short-term monetary savings in operations costs. Over the long-term it will deliver increased profit margins with a return in savings paying for its original cost. The Combi will provide a return in savings to pay for the purchase price in twenty months (see appendix). • Labour Cost The labour cost will be reduced immediately by utilizing the Self cooking microprocessor feature, which automates the cooking process and optimizes capacity of output in preparation. It will allow for a savings of .6 FTE’s per week or $1,460.76 dollars a month (see appendix). • Food Cost The food cost will be reduced by the Combi’s efficiency in yield results with IQT technology. An approximate 22% savings in raw material and 95% savings in fats and oils used in the
cooking process (see appendix). Its precision cooking technology will reduce waste due to improper cooking and human error. • Energy Conservation Conservation mechanisms will reduce cost by compensating energy usage by reducing power to complete the cooking and holding time and temperatures. A savings of $906.00 dollars per year in energy costs will be saved (see appendix). Its energy features control the use of energy during peak loads and continuous operation to provide an additional 2% savings per year • Equipment Expenditures Expenditures will be dramatically reduced in the immediate and long-term. The Combi’s seven different cooking modes replace the need for acquisition of other conventional cooking appliances such as convection ovens, ranges, deep fryers, and steamers. Customer Satisfaction The quality of the food and resident’s satisfaction will be immediately improved with the use of the Combi. It provides seven distinct cooking modes to increase more options in methods preparations and styles of cooking. This is an improvement to the limits of the current equipment. The model’s IQT sensor technology will provide a consistent custom finished product, which will assist in standardizing resident’s preferences
2 Most importantly the Combi will eliminate the possibility of health and safety incidents. Its automated self-contained maintenance features and built in safety mechanisms minimize human intervention during the cooking and cleaning process. The CleanJet and CalcDiagnosis cleaning systems reduce the possibility of human error and accidents. The automated HACCP logging system reduces manual monitoring, recording, and interpreting time and temperature data. Recommendations The mission statement for the foodservice department is to deliver exceptional experiences with exceptional people, product, and service. Provided the Rational Combi the department can both achieve the department’s mission and deliver the goals of the facility’s strategic plans. In creating exceptional experiences for our residents and staff we may optimize profits, operating cost, and health and safety procedures. Based on the above benefits it would be advantageous to approve the purchase of the Rational Combi model.
NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Template Week (enter week #): (Enter assignment title) Student Name College of Nursing-PMHNP, Walden University NRNP 6635: Psychopathology and Diagnostic Reasoning Faculty Name Assignment Due Date Subjective: CC (chief complaint): HPI: (include psychiatric ROS rule out) Past Psychiatric History: · General Statement: · Caregivers (if applicable): · Hospitalizations: · Medication trials: · Psychotherapy or Previous Psychiatric Diagnosis: Substance Current Use and History: Family Psychiatric/Substance Use History: Psychosocial History: Medical History: · Current Medications: · Allergies:
· Reproductive Hx: Objective: Diagnostic results: Assessment: Mental Status Examination: Differential Diagnoses: Reflections: Case Formulation and Treatment Plan: References © 2021 Walden University Page 2 of 3 NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Template INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.
In the Subjective section, provide: · Chief complaint · History of present illness (HPI) · Past psychiatric history · Medication trials and current medications · Psychotherapy or previous psychiatric diagnosis · Pertinent substance use, family psychiatric/substance use, social, and medical history · Allergies · ROS · Read rating descriptions to see the grading standards! In the Objective section, provide: · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses. · Read rating descriptions to see the grading standards! In the Assessment section, provide: · Results of the mental status examination, presented in paragraph form. · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5
diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. · Read rating descriptions to see the grading standards! Reflect on this case. Include what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). (The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.) EXEMPLAR BEGINS HERE CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why they are presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member. HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication, and referral reason. For example:
N.M. is a 34-year-old Asian male who presents for psychotherapeutic evaluation for anxiety. He is currently prescribed sertraline by (?) which he finds ineffective. His PCP referred him for evaluation and treatment. Or P.H. is a 16-year-old Hispanic female who presents for psychotherapeutic evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her mental health provider for evaluation and treatment. Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, the duration, the frequency, the severity, and the impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders. You will complete a psychiatric ROS to rule out other psychiatric illnesses. Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13. Caregivers are listed if applicable.
Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors? Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it) Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. (Or, you could document both.) Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures. Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information (be sure to include a reader’s key to your genogram) or write up in narrative form. Psychosocial History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:
· Where patient was born, who raised the patient · Number of brothers/sisters (what order is the patient within siblings) · Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children? · Educational Level · Hobbies · Work History: currently working/profession, disabled, unemployed, retired? · Legal history: past hx, any current issues? · Trauma history: Any childhood or adult history of trauma? · Violence Hx:Concern or issues about safety (personal, home, community, sexual (current & historical) Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries. Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products. Allergies:Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance. Reproductive Hx:Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns
Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines). Assessment Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudo hallucinations, illusions, etc.), cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form. He is an 8 yo African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinki ng. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good. Differential Diagnoses:You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case. Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s treatment of the patient and why or why not. What did you learn
from this case? What would you do differently? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). Case Formulation and Treatment Plan. Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions with psychotherapy, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. *see an example below—you will modify to your practice so there may be information excluded/included—what does your preceptor document? Example: Initiation of (what form/type) of individual, group, or family psychotherapy and frequency. Documentation of any resources you provide for patient education or coping/relaxation skills, homework for next appointment. Client has emergency numbers: Emergency Services 911, the Client's Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them) Reviewed hospital records/therapist records for collaborative information; Reviewed PCP report (only if actually available) Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment
regimen as discussed. (This relates to informed consent; you will need to assess their understanding and agreement.) Follow up with PCP as needed and/or for: Write out what psychotherapy testing or screening ordered/conducted, rationale for ordering Any other community or provider referrals Return to clinic: Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care OR if one-time evaluation, say so and any other follow up plans. References (move to begin on next page) You are required to include at least three evidence-based, peer- reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. © 2021 Walden University Page 1 of 6 A MOTHER and A DAUGHTER: 00:00:35A CULTURAL TALE 00:00:35AN INTERVIEW WITH 00:00:35GONZALO BACIGALUPE, PhD 00:00:35Produced by 00:00:35Andrews & Clark
00:00:35Explorations, Inc. 00:00:35copyright 2003 00:00:35GONZALO BACIGALUPE When I'm asked to do a consultation, one of the first things I ask is, what will be the most benefit for the client and the therapist and in the case that you're going to see I'm basically asked to have a reflecting team and what we did was first have an interview with the therapist and the family and ask them what they will find useful for the interview and basically to ask them about the history of the therapy and the history of what are the kinds of things that they have been working on. I ask the reflecting team to come in and I instructed them to think of themselves as so let the god mothers of the therapist, who in a way, put them, himself, or in this case herself at risk in front of her peers and another people. So, I wanted them, the reflecting team to address the therapeutic system as a whole not just to address the family, I wanted them to talk also about the therapist and to be protective of them. I also ask the reflecting team not to be too much of clinician, but to really react on a more personal level around the family. I sometimes reflected on what they were saying to clarify or to expand the idea or how I understood it to give voice to other possibilities, but respecting the personal peace, and then, I ask I ask the family to come back to, in a classical way, to respond to those comments what strike them. In the case that we watch, it seems that the family was dealing with sort of like two forms of trauma and/or three forms of trauma; one is, history of battering the domestic violence, child sexual abuse, a history of immigration that in some ways we lay it to that trauma getting away from it and basically the mother of five children deciding that they need to move out of the home, but in the process leaving one behind who is later on sexually, I mean, raped by the father. And then at the present moment mother dealing with a fairly traumatic illness that have her, very disable, unable to walk and to work. So, it's sort of like the interview trying to address this different forms of trauma and the way in which the young adults are trying to
make sense of their bicultural life and how the whole family is trying to make sense of being bicultural and being immigrants. The session doesn't end with a need or incredible intervention of my part because I feel that this is the part of the therapist to try to decide, this is the family that's been working this therapist for year and half. Therefore, they have a relationship I feel that I need to respect and so those are the basic intercomments. So tell me how is it that you came out with the idea of having this interview with me? 00:04:30Sharleen 00:04:30Patti 00:04:30SANDI Okay. I'm going to go back when Patti came in for the first time. She came in because they were chaos at her household. 00:04:45Sandi - their therapist 00:04:45SANDI She came to this country twelve years ago with her four children and one was left behind, her daughter who was 10 years old at that time, eight years old at that time, was left behind. Just two years back, finally they were able to get her visa and she brought her to United States. So ever since she came here chaos was created inside the household. 00:05:20GONZALO BACIGALUPE So I'm clear, Sharleen you are? 00:05:25SHARLEEN Her daughter. 00:05:25GONZALO BACIGALUPE Her daughter. And how old are you? 00:05:25SHARLEEN I'm 23. 00:05:25GONZALO BACIGALUPE 23, and how old are your siblings? 00:05:30SHARLEEN 24. 00:05:30GONZALO BACIGALUPE And that's sister or brother? 00:05:35PATTI Sister. 00:05:35SHARLEEN And then 21-year old sister and 18-year old brother and a 15-year old brother. 00:05:50GONZALO BACIGALUPE Okay, and which one is the
one that stayed there. 00:05:50SHARLEEN 21. 00:05:50SANDI 21. 00:05:50GONZALO BACIGALUPE 21. Okay. All right. Okay. Go ahead, sorry. 00:05:55SANDI And I met with the entire family for two couple of sessions and she really interested and wanted to be in therapy 21, so. 00:06:10GONZALO BACIGALUPE What's her name? 00:06:10SANDI Shireen. 00:06:15Shireen - the 21 year old sister 00:06:15emigrated from Iran 2 years ago 00:06:15GONZALO BACIGALUPE Okay. 00:06:15SANDI She just felt that she needed the money more than coming to therapy and she refused the entire time and mom tried to she ask her, if she doesn't feel comfortable with me. She said she has had all appointments with other therapists at this clinic, still she refused to come in, but they kept on seeing Patti and the oldest daughter Sheela for about a year and a half now. Ever since then, we started working on the chaos in the household, what is it that creating chaos and I found out that Patti lives with traditional ways of living, their daughters are trying to detach herself from Patti and grow on their own and find their own individuality. So would ask where they have been working on and every since then she had two surgeries. 00:07:30Patti had surgery on both feet. 00:07:30SANDI Every thing is started. 00:07:35GONZALO BACIGALUPE Who had two surgeries? 00:07:35SANDI Patti had two surgeries on her feet. 00:07:40Surgery failed - she is disabled. 00:07:40SANDI And that created more tension, anxiety in the family. 00:07:50She is in constant pain. 00:07:50SANDI So -- and I have been seeing her after her surgery and she has been referred to a psychiatrist for medication because a lot of time she feels hopeless, helpless,
she feels her children are out of control, she can't be in charge, they no need her anymore. So those are the major. 00:08:20GONZALO BACIGALUPE If you were to describe an accomplishment and you have accomplishment with the therapists during this time. Is there something that you will say, it's an important accomplishment? 00:08:35SANDI Awareness of the difference between individualist ways of living and collectivistic ways of living and awareness that how they to respect and understand the children are growing in this country and they are going to try to detach themselves from Patti to be able to grow on their own. 00:09:00GONZALO BACIGALUPE What has been for you this work with Sandi? 00:09:05PATTI She helped me to understand the kids grow up and left the house and they have been not to depend on them so many times and try to live my life alone and then to take care of my things, my problem in the life and respect them and give them their freedom. 00:09:30GONZALO BACIGALUPE Do you have a sense that that is sort word that has been accomplished that is more to be done. 00:09:35PATTI I think I need more to be done, I'm not done. No. 00:09:40GONZALO BACIGALUPE Do you have of sense of what is that you would like to do? 00:09:45PATTI Yeah, I'd like to learn to lead my life alone and depend on the kids a lot because in our custom when the parents get old and especially when they are in my situation they can't walk or take care of theirself, the kids are always there for parents, but over here no, they have their own life. And I expect them to be there all of the time for me and they can't, matter of fact, I had a big argument with her last night about that, I had a very bad back for few days I was done and last night, I called her and I said come and spend a night with me and she said no, I can't. I said, you should and you have to and we got into a
big argument. 00:10:30GONZALO BACIGALUPE So, you are on your own right now, you're living in your own and each of the kids have their own place or? 00:10:35PATTI Three of them, two of the boys lived with me 18 and 15 years old, but the 15 years old was with her for three four days and I was with 18 years old a lot. I feel like they doesn't do enough for me. 00:10:50SHARLEEN She makes her own plans for me, she expects me to like to go with her and spend time with her because she is bored. I have too much to do, I can't unwind your boredness, find something else to do, but I have plans, I'm 24 and my world around me is happening and I need to be there, I accomplish things. I can't sit down and like chitchat for a whole day. 00:11:15PATTI And I feel I'm depressed I cannot move, I need them to come and visit me, spend a night with me. 00:11:20SHARLEEN I spend, I -- out of the seven days, I saw her for six days, I make sure, I saw her for six days out of that week. I spent a day with a friend and I got some stuff done and she felt like I owe her something because I didn't spend that time with her. And she did a nice job raising us, she was a wonderful mother, we all suffered through the good and the bad in the family like every family does, but we have all grown up, we can't stay in the nest forever. I'm trying to experience life and my own good or bad, whether you approve it or not, it's my life. 00:11:55GONZALO BACIGALUPE Sharleen, is this something that you have had a discussion, the three of you, I mean this particular or this is not like? 00:12:00SHARLEEN I think, I have mentioned to her, but she takes it personal, she doesn't hear me out. 00:12:05GONZALO BACIGALUPE Is this something that you have had conversations with the family? 00:12:10SANDI Over and over, yes. Especially with the oldest daughter Sheela, she also, being the oldest, she feels that she
has been the parentified child all her life, she has played a role of a man for -- in her mother's life and then the entire, I've seen her for about four times right, four, five times and she used to cry the entire time in the session. 00:12:40GONZALO BACIGALUPE And I realize that you're being very touched by this, I mean this is not something that. 00:12:45SHARLEEN Yeah, it's something that I strive so hard to accomplish and as soon as I feel like I got her on the right step, there she goes falling depart again asking for like, I give her what I can and she keeps on asking for more and more and that's not how my life works. 00:13:05GONZALO BACIGALUPE What do you right now? Are you working, studying? 00:13:05SHARLEEN Yeah, I work and I'm trying to get my license. I'm trying to get accomplish things from now. 00:13:15GONZALO BACIGALUPE What kind of work are you are doing right now? 00:13:15SHARLEEN I just -- I find promotional jobs and then, I'm trying to get my real estate license. 00:13:25GONZALO BACIGALUPE And your sister? 00:13:30SHARLEEN Sheela? 00:13:30GONZALO BACIGALUPE Sheela, is she also on her own? 00:13:30SHARLEEN Yeah. 00:13:30GONZALO BACIGALUPE She is also working, studying? And the 18-year old, what is he doing? 00:13:35PATTI He is a student. 00:13:40GONZALO BACIGALUPE In high school? 00:13:40PATTI Yes. 00:13:40GONZALO BACIGALUPE So, he is finishing high school right now? 00:13:40PATTI Yes, this year. 00:13:45GONZALO BACIGALUPE And is he talking also about leaving home after finishing the high school or what are his plans? 00:13:50SHARLEEN He is not sure yet, depends on how the
family situation is going, you know, everybody looks for happiness and peace of mind, depends like how he feels around the home. 00:14:00GONZALO BACIGALUPE How about the 15-year old? 00:14:00PATTI I have lots of problems with him, I don't get long with him at all. 00:14:05SHARLEEN She has no patience. And she takes it out on other people. 00:14:10PATTI Because I can't do anything, I walk fewer step and that's it, I have a horrible pain after fewer step. And I have to sit and wait for them to come and give me a glass of water. 00:14:25SHARLEEN Well, the thing is I want her not to wait for us, I want her to be on her own, I want her to learn how to like, you know there is a -- you know superman lost his both feet and he sits on a wheel chair, but he is still going on with life. 00:14:40PATTI But Superman has money, somebody take care of him all of the time. 00:14:40SHARLEEN You have to learn how to ease your own mind and not depend on other people. She is forty years old, if she was 60, poor dying lady, I would be more sympathetic, just 40 years old, there is much more for her to experience. It's not time for her to start depending on her children yet. We're only in our 20s, let me live life, let me experience and do what you can, while you can. Give it your best. 00:15:10GONZALO BACIGALUPE Sharleen, how is that you decided to come today, I mean what's it? 00:15:10SHARLEEN Because I was with her last week and they asked me to, they invited me to, so I thought maybe you would like help as much as this is helping you. 00:15:20GONZALO BACIGALUPE Do you have a sense that you are sort of being representative of the other of your siblings that you are coming as a representative for all of them in some way?
00:15:30SHARLEEN We are all trying to get her to be more positive and feel like do a little step at a day, but try your best to be better, to do a better in life. Every time I try to push her to be more independent and not as much like do that all stuff with her that she could do on her own, she keeps like she has a broken wing that she wants to buoy on us, after a while, it gets heavy. You just want it off because I want to breathe and I want to experience my life. I cannot live like a 20-year old from Iran. I have different things to experience than to sit at home. And the thing is like I don't feel like I can accomplish with her when I'm at home because she is either watching TV or on the phone, which is just like sad people around and I can't hang out like that. 00:16:20GONZALO BACIGALUPE Besides the -- your five kids and yourself, is there anybody else in the family here who immigrated with you guys or --? 00:16:25PATTI I have a cousin, but they live LA and I don't even talk to them. 00:16:35GONZALO BACIGALUPE And so, in a way, when you need something, basically the only thing that you feel like you can go for your kids? When you -- we're talking about chaos, there have been -- there were some chaos about a year and half ago when we start through the work and can you tell me little bit about what the chaos was about or what -- how you define that? 00:17:00SANDI Okay. I just want to mention something about before her surgery Patti has been a very independent women as far as working hard, single mother, raising all her children and they are all proud of her in many ways. When they came she did not have the health problem as far as the pain in her feet, constant pain and feeling hopeless and helpless. They came for a different reason was for Shireen, because Shireen came form Iran and two weeks everything was wonderful, they all re-united, they enjoyed, celebrated for two weeks, and then, she started telling him about the stories that her father abused her sexually, physically and she was
abandoned in their house. So, that's where the explosion, the chaos started. Before that -- 00:18:05GONZALO BACIGALUPE When you say that the chaos started, what started to happen? 00:18:05SANDI They were fighting, constant fighting, screaming, yelling and cursing each other. Before that, my understanding was that kind of was a very peaceful way of living, am I correct in this? 00:18:25GONZALO BACIGALUPE Okay. All right, so the tension has really sky rocketed after Sheela came back, I mean, two weeks after one, and then, he came out of that -- there's been this --? 00:18:35PATTI As she came back, she was blaming me, why did you left me back home with my dad there, he did all of those things to me. And my husband used to tell her, you was a rotten fruit and she didn't take you, you are a rotten one. She took the good ones and left you behind for me. And she was blaming me for everything. 00:18:55GONZALO BACIGALUPE When you left, you had separated from your husband? 00:19:00PATTI No, we were living together my daughter had a medical problem, Sheela and matter of fact, her, and they give me a medical visa to come here and Sheela and Sharleen born here many years ago. And when I went to get a Visa, they told me two of them are American citizen, you have to take them, we cannot say no. And my boys were four years old then 18 months old and Shireen was eight and they said, they decide Shireen should be stayed home and make it sure I'll will be go back. But after I came here, my daughter didn't have any problem any more and they were find and I used to stay here and I decided to live here. And my husband was keep telling me don't come, don't come, stay there, I will come some day and he never sent me any money, he never did anything for us at all except sending the letter 10 pages every single day, what to do, how to leave and how to raise the kids and I throw them all in the trash because I didn't had a time to read them and I didn't had time to
practice anything he said and I ignored everything until like six, seven years later, he just wrote a letter, I want you to be back home, you are my wife, I order you to back home and I said, forget about you, I have my life here. And who wants to go back to that life. And I was thrown all of the time to bring Shireen and I couldn't until three years ago. Finally, she came and for couple of days, weeks everything was fine until she started talking about every problem she had back home and for any little mistakes she made, my husband used to beat her up and keep her outside the house for all night and many, many things, the things he used to do to me. And I know what she talking about and what she had to go through, but I couldn't do anything about it. I didn't have the choice. When I came here few week after, few months after I was here I called my dad and I said, I'm worried about Shireen, I afraid to beat her and I'm not there to protect them because I was all this over to protect the kids. Each time he wants to beat them, I was right ahead of them and say, beat me, don't touch my kids, do whatever you want with me. And my dad said you should imagine your house was in the fire, you took four of them off the fire, you left one behind, leave her behind and take care of those four you have and I thought about it, I thought, he is very right, absolutely right, I should take care of the four I have over here. Why should I go back there. He would be -- make everybody miserable. I didn't have a very good life but like she said, we all worked together and take care of each other and like I was out all of the time and like Sheela said, she was father of the kid, take care of the kids, take care of the bank account, his groceries, everything. And I used to be a care giver and save it all this and Sheela and Sharleen would stay home and take care of the kids, two younger brother and each other. And everything was okay until Shireen came. And then, after few months, for a couple of years, we had a problem until, thanks god, last May she got married with somebody behind our back. 00:22:25GONZALO BACIGALUPE Who got married?
00:22:25PATTI Shireen, we were on the camping three when she ran away with one of my friend's son and got married and she moved out the house and my house is so quiet and I enjoy the life so much except I get so depressed because I feel hopeless and I have so much pain and they can't do anything about my pain, I'm always in pain. 00:22:50GONZALO BACIGALUPE As you must have seen, when -- do you work on how they make sense of what happen to Shireen, I mean, in Iran during the time that she was alone, was that workout with the whole family, they were some sort of a conversation in therapy? 00:23:05SANDI Yes, I met, as I remember, I met with all of them and they expressed their feelings and shouting, yelling, everything was going on in our session. And they were expressing, Shireen was constantly blaming the mother for all her pain and what happened to her to lead on and a mother tried to explain her situation, the sisters also, brothers also. So, we had few sessions like that. 00:23:35GONZALO BACIGALUPE What was your sense of how it can -- that there were some sort a resolution around that that people were able to make sense that Patti and the kids were able to make sense of this or? 00:23:50SANDI I was hoping for that, that was my really aim to discover, explore their meanings of the situation and. 00:24:00PATTI They got in fight, we couldn't keep coming back, I couldn't make them to go back as a family. 00:24:05GONZALO BACIGALUPE Is it still something that is very hard to talk about or not? 00:24:10PATTI About the rape you mean? 00:24:10GONZALO BACIGALUPE Yeah? 00:24:10PATTI What do you think? 00:24:15SHARLEEN Well, I'm not very worried about, I mean, it's affecting her life and I feel sorry for her, but I try not to think about it. 00:24:25GONZALO BACIGALUPE And do you have the sense that that's what anybody else in the family tries to do that tries
hard so they doesn't affect? 00:24:30SHARLEEN Because we already did our crying over it and I'm over it, I'm ready to move on about it. 00:24:40PATTI It's like when somebody die, you grieve for it. When I heard about it, I was crying and crying and crying for months and months, and then later on, it's something you can't do any thing about this, something happened, what am I going to do about it. I tried to take her to counseling, I take her to Iranian psychologist, 200 dollars an hour. And she would then go back, then what can I do. And I think I'm over with it, I feel sorry for her, but what can I do. My older son doesn't want to talk to this, his dad, nobody wants to contact him or have any relationship or any thing to -- 00:25:20GONZALO BACIGALUPE Has he acknowledged that he did rape her? 00:25:25PATTI I told him once, and he will start cursing at me and I hang up. I said, I pay a dollar fifty a minute, I don't want to hear your cursing. I want to see what's going on, what happened and you tell me if it happened or not and will start cursing and I hang up. And after that, I never called back, and he is remarried, he married to Iris after Shireen came, during the three years, he got married twice and he has moved on with his life. 00:25:55GONZALO BACIGALUPE Is there any, I mean, is there a way in which you think, I mean you, Sharleen and maybe some of your siblings, but just from your perspective, is there where you think about how the relationship with your mom should be, is it -- do you have a dream for how? 00:26:15SHARLEEN Yeah, I just wanted her to be more peaceful. I want her to lower her expectations and to accept a lot of things about life. 00:26:25GONZALO BACIGALUPE What do you mean lower expectations, what? 00:26:25SHARLEEN Not to expect so much from people, not to -- I think what she does is, she thinks of an idea and she reacts on it so so quick without she calming herself down before she
like takes the reaction. 00:26:40GONZALO BACIGALUPE Do you have a sense that your mom thinks that you can do more than what you can actually do? 00:26:45SHARLEEN I have a sense that she is holding me back from doing all that I could be doing and as soon as I could get excited about her, every time I give her little bit of hope, there she goes back expecting more, and then, getting angry at. She has some thoughts then she is so hang up that these thoughts are like so true and she gets angry about them and she hold on to them, then she accuses people and all they are her thoughts in her mind. And I just ask her to leave them alone, let people be and everything is going to -- just then it's going to take its course. 00:27:15GONZALO BACIGALUPE Am I trying to tell you, if you were to think about how your ambition, how you see it in the future, the relation how do you see it? I mean, if you were to move in a way the direction that you want it to move, how many times do you see yourself beside in her or interacting with her? 00:27:35SHARLEEN I speak to her every day, I mean almost everyday. 00:27:40GONZALO BACIGALUPE But again, I'm asking you more about -- 00:27:40SHARLEEN Like in the future, yeah, I just want her to like be more calm about like life so that I could like through her better. So that when I do spend time with her that I could enjoy it better instead of her frightening my other siblings or telling me about how so and so, this and that and this and that. I just want her to be more calm so we could just enjoy the moment when we hang out, rather than like. 00:28:05GONZALO BACIGALUPE What kinds of things do you enjoy with her in the moment? 00:28:10SHARLEEN I try to tell her about my ideas, how she is like be more relaxed and not -- you know same things. 00:28:15GONZALO BACIGALUPE Patti, how do you ambition
the relationship with your daughter? 00:28:20PATTI I saw her on Sunday, Sunday night and Sunday night, I went to visit my older daughter and she was aware that I took the dinner for them. And after I laid down fully at my daughter, older daughter house, I couldn't get up, they pulled me and took me to the car and I came home. I didn't see her until yesterday afternoon and I said, I have been done with my bag. I just want them to spend time with me. I'm lonely, I get depressed when I'm lonely. If she had a job, if she was working like the other people, I would understand she is working everyday like my older daughter, she go to her school, she work, I understand she doesn't have a time, but I know she has time and I expect her to come and spend the time. And I said, I gave you whatever you want, whatever I have in the house like furniture, this and that, anything she said, mom can I have this? Sure, honey, doesn't matter you or me, you can have it. And when I'm like that with you, I expect you to do something for me too. 00:29:20GONZALO BACIGALUPE Patti, I understand how also you are feeling upset about this, about and I know that the question I'm asking is hard, I mean, how do ambition the relationship with Sharleen? What will you like to happen in the future? 00:29:40PATTI Between me and her? I want her to just spend time with me whenever she can. 00:29:45GONZALO BACIGALUPE What kind of time for instance would you like to --? 00:29:45PATTI She come and stay at my house because she knows I cannot live with two boys and go to her house. She most of the time ask me to come and stay at my house, but when I go to her house and I spend over there, I'm worried about 18 years old I have at home. 00:30:05GONZALO BACIGALUPE And do you have a sense of how many times, how many nights that you would like her to spend with you in your home? 00:30:10PATTI Once a week is good if she come and stay the
day or night, once a week with me is fine, but when she come like one hour, half hour, she is for example, going to go see so and so to keep a board work, she will stop at my house to have a drink the water or say, hi mother, how are you? 00:30:30SHARLEEN Two, three hours? 00:30:30PATTI That's not a visit for me, I wanted to come with me and spend the time with me and stay with me that day. 00:30:35SHARLEEN When I go over there, she is either on the phone or she is watching TV, I'm very, very uncomfortable in her house like to where I cannot stand sitting down because she has two dogs around and I don't like those things. I don't like the hair on my body. When I touch an animal, I wash my hands before I eat. She has two dogs, there is dog here on the couch, dog here on the floor, dog here on the chairs, there is dogs all around. I don't want to eat anything because the dishes smell like dogs, I'm not comfortable. I don't enjoy that, it's not pleasant to me. I could only do it so much at a time. I express that to her, you have dogs, I can't eat either your dishes. That's my culture, that's how I was brought up and I thought that's how she was brought up. So, she surprises me when she does these things, she makes the family unhappy because nobody wants to see dogs, it smells like dogs in her house. 00:31:25PATTI How come you don't do the other things, you grow up and have a cold chill like, that's just the only thing you know. 00:31:35SHARLEEN I don't -- I cannot stand it, I cannot stand it. 00:31:35PATTI And they give me so much happiness, they make me so happy, I love them so much. 00:31:40SHARLEEN I don't like it. 00:31:40PATTI And I never ever going to get rid of them. 00:31:45SHARLEEN I don't like it, don't ask me to sleep in the pillow, it's that the dogs stinks. 00:31:45PATTI Actually, you know we have a guest room, the dogs doesn't in that room. 00:31:50SHARLEEN I cannot sleep in motels, I cannot
use other people's bed, I cannot sleep with dogs, I cannot do these things. 00:31:55PATTI You know that bed brand new and you know the sheets and everything brand new in the guest room and you know that that door is closed. 00:32:05SHARLEEN I'm not enjoying it, I cannot eat breakfast, when I'm thirsty I can't drink water there. 00:32:05GONZALO BACIGALUPE Let me ask you, is this the kind of sometimes the -- where the discussions go? 00:32:10SHARLEEN Yeah. 00:32:10GONZALO BACIGA And if I were to let you go over the discussion where will it end, one of you will leave the room or --? 00:32:20SHARLEEN I will start screaming. 00:32:20PATTI Screaming, yeah. 00:32:20SHARLEEN And disrespecting and calling names. 00:32:25PATTI I do. 00:32:25SHARLEEN At this stage, I don't -- 00:32:25GONZALO BACIGALUPE And you would be like, I don't want to see you, I don't want to talk to you anymore. 00:32:30SHARLEEN I'm trying to become a woman, I'm trying to became a lady. And when I go to her house, she treats me disrespectfully like that about her dogs, she would curse me out and I just feel, oh, what a mother. 00:32:40GONZALO BACIGALUPE Would you say both of you that you would like that not to happen that you will not get into this. 00:32:45PATTI Of course I love them. 00:32:50GONZALO BACIGALUPE Do you sometimes dream with, been able to relate to each other without having to get into this. 00:32:55SHARLEEN Of course, I do. 00:33:00PATTI I feel even we argue, we still love each other and I feel like, they are my kids, they will be still here for me if I need them really. And they have been until sometimes lately. 00:33:10SHARLEEN I just want her to appreciate and not to
expect and expect just like take what people give you and just be happy. 00:33:20GONZALO BACIGALUPE We're going to stop a little bit now. 00:33:25Reflecting Team Enters 00:33:25Isaac 00:33:25ISAAC I'm Isaac and I really resonated with Sharleen. I come from, well my parents emigrated here. 00:33:40GONZALO BACIGALUPE Where your parents came from? 00:33:40ISAAC Korea, and I was born in the States, but there are still this cultural tension that we experienced within our family. And so when she was talking about the difference of cultures and who she is and there was a little bit of disparity between her Iranian culture and the American cultures in her life and I experienced that in my life too. So, I really understood that and I thought, you know what? I'm not the only one that went through that. And if I'm not the only one then she is not the only one either, so something that I guess happens in a culture of people when they immigrate into another country. 00:34:30GONZALO BACIGALUPE How old were you when you immigrated? 00:34:30ISAAC I was born here. 00:34:30GONZALO BACIGALUPE You were born here, but still -- 00:34:35ISAAC My parents, my parents moved here. When they were in their mid-20s, they moved here. And then I was born and shortly after they moved here. And so there was a been influence there. 00:34:50GONZALO BACIGALUPE All right, cool. 00:34:50Roberta 00:34:50ROBERTA My name is Roberta and these things really struck out with me because I have seen Patti before. I have been on the reflecting team. And I'm amazed at the difference in her, how much younger she looks and more vibrant than the last month I had seen her. So, I was very impressed by her change.
Another thing that just really struck out from me was when Sharleen was talking about what she didn't want to do, and then, Patti talked about when her husband had sent her the letters and said, come home and Patti didn't want to go home and it was almost like it was the same conversation, only held with different people. And I thought that was rather interesting that they are both having the same things happen in their life at different times, but they both wanted their independence. And I saw that realistic out from me, so that was very interesting. 00:35:45GONZALO BACIGALUPE Yeah, it's interesting, I was -- I don't know if it's the same you are saying, but how can you have your independence, but at the same time, still stay connected? It's a hard one. 00:35:55ROBERTA And they are fighting to stay connected. 00:36:00Dorothy 00:36:00DOROTHY First of all, I'm really impressed with Sandi, the therapist and working with this family and having the care and the love that it concerns between all of them, including Sandi as a therapist. And I really relate it to Patti because I have six children and I watched them one leave one at a time and so I know what that feels like. 00:36:25GONZALO BACIGALUPE What it feels like? 00:36:25DOROTHY Well, it is -- it feels like a tragedy really each time. There is always, there's something to deal with because it's a grieving, you are letting go. You are letting go and I really relate it to her on that level, completely, but I didn't have the kind of real tragedies to deal with that Patti has had to deal with, in addition to this letting go, okay. She has had the, well, the disability to deal with in the pain, the constant pain that she deals with and also then the tragedy in her daughter's life and what must come up for a mother in dealing with that. I mean, unavoidable in the situation, of course, but still she was dealing with that. At the same time, with all of this other emotional stuff that I know about. So, I just have a lot of respect for her and I noticed that she has done a good job with her children. How wise Sharleen is for a age, very wise, so.
00:37:35GONZALO BACIGALUPE In a way, Roberta? 00:37:40DOROTHY Dorothy. 00:37:40GONZALO BACIGALUPE Dorothy, in a way it is if it's Sharleen's need for independence is in a way due to her mom's wanting her to be independent to and sort of like I mean she has to get it from somewhere right? 00:37:55DOROTHY Yes. 00:37:55GONZALO BACIGALUPE Yeah. 00:37:55Amber 00:37:55AMBER Yeah that was a kind of a question I had. Well, what were Patti's dreams for her children in making this enormous transition from Iran, right. 00:38:05GONZALO BACIGALUPE Yeah. 00:38:05AMBER To the States, this huge transition, I mean, there must have been a dream, some purpose that was bringing her over here, and I was really curious what her thoughts back, I guess, 20 years ago or something like that. And I loved Sharleen's metaphor of the birds, the wings feeling, really weighing her down right now. 00:38:30GONZALO BACIGALUPE And at the same the time, the wings are supposed to be as somewhat you fly on. Yeah. 00:38:35AMBER Yeah. And so at that kind tied into my thoughts about what were Patti's dreams for her -- duckling in a way. I do not just kind of rambling thoughts about duckling is calling around and the infant their mom and their mind they follow her around forever even when they grow up, but they do eventually gained some distance more than they had. 00:39:00GONZALO BACIGALUPE Maybe one comment, so maybe you want to say something else, I mean, maybe there is a couple of burning comments that people want to -- 00:39:05ISAAC I know the family really loves each other. Even if they argue, you see that there is a sense of care and compassion there for each other and I don't think that. 00:39:20GONZALO BACIGALUPE And in that sense, it must be very frustrating to get into this stuff, it's like. 00:39:25ISAAC Oh yeah, absolutely.
00:39:25AMBER Yeah Patti made that comment. Even when we are fighting, I know we love each other. 00:39:30ISAAC I said they're going, you know, that's exactly right, when she said that and even though, Sharleen is -- it seems like it's little bit tough love going on, on behalf -- from Sharleen's part of she representing all the kids, from kids towards their mom, and saying, mom, they love you, but we want you to be able to function on your own and I don't know how that kind of fits in with everybody. 00:40:00GONZALO BACIGALUPE Yeah. I was wondering what it is for a kid even if it's an adult, I mean and clearly these are -- kids were becoming adults I mean, Sharleen put it very well. But it must be really hard to see your mom becoming a little bit, you know sometimes like a kid to, I mean, that they need to take care of so soon. 00:40:25ISAAC Yeah. 00:40:25ROBERTA And she made that comment if she was older it would be different, but she is younger. And I don't think they expected, I imagine she is torn with wanting to live her own life and wanting to take care of her mom, I'm sure she is struggling deeply. 00:40:45GONZALO BACIGALUPE Any of you thinking as a therapist, putting yourself in Sandi's shoes and anything that you may think that Sandi is having to deal with or some dilemma that she may be struggling with? 00:41:00ROBERTA What I felt for Sandi, because I think this must be very difficult for her also to, because the families seems even though they have said they have grown and they have made changes that they are almost stuck on that and I imagine Sandi is probably having a hard time getting over that stuckness, and so that's what I see Sandi probably struggling with. It's just being stuck and where do I go from here, where do I take the family from here? 00:41:30GONZALO BACIGALUPE I was wondering, I mean, and the reason I guess I had a self-interest in asking because I was wondering and wanted to check with you guys, I mean,
since she's also from Iran I mean, people might think that she is more of an expert on this family. And of course, there are things that have to do with being from Iran. Also, the things that probably have to do with being an immigrant, but also there is some tragic things that have happened in this family and that you know, so I wonder how she at sometimes might feel like not necessary knowing what to do and while at the same time, feeling very well connected with this family. 00:42:05AMBER Oh I think she is. 00:42:10ROBERTA She shows she's well connected with that. 00:42:10DOROTHY Oh yeah. And it must be very frustrating because how do you improve the quality of life for Patti, especially for the family in general, I mean, it must be very frustrating. I mean, what concrete steps do to take. 00:42:30GONZALO BACIGALUPE Okay. Alright. Thank you. 00:42:35Family & Sandi Return 00:42:35GONZALO BACIGALUPE I generally ask after this, we call this is a reflecting team, if you had any reactions, any thoughts or -- and you don't need to address everything that was -- I mean, anything that strike you? 00:42:50SANDI For me, I really felt that they hit -- they touched the right sensitive part as far as being stuck, I'm always thinking okay, what else, what can I do to really -- what can I, I come with ideas of goal setting, achieving goals, and trying to figure out what else can I do, so the family can -- 00:43:25GONZALO BACIGALUPE Move forward. 00:43:25SANDI Move forward. 00:43:25GONZALO BACIGALUPE Patti, did you, of what, all what you heard, there was something that struck you something new or interesting or --? 00:43:35PATTI Nothing, they just talk about discipline on this - - think you were asking me about Shireen, how do I feel and I told you I have been grieved and it's over, but I was thinking about, it's always in my head. I don't think I never going to forget it. It's always in my head and sometimes I feel like, maybe if I was there, it wouldn't happen and then I think
about rest of them, what could have happened to the rest of them, maybe if I'd take them all, what would be happened to all of them. So, I don't know. 00:44:20GONZALO BACIGALUPE Do you move back and forth between that. Sharleen how about you, anything that strike you as? 00:44:25SHARLEEN Oh pretty much everything everybody said was really interesting to hear about. 00:44:30GONZALO BACIGALUPE Anything in particular that? 00:44:35SHARLEEN I don't think so. 00:44:35GONZALO BACIGALUPE You don't think so. Is there a movement and this is something that it's like you have been working for a year and a half, you have been going through some very difficult stuff. Do you see yourselves and maybe you can imagine your siblings thinking about this. Having other, so like very difficult conversations therapy, I mean do you see yourselves having to deal with tough issues? Or will you say that this is the worst so to speak? 00:45:25PATTI This is the worst. Just argue with them because I love them and I don't want to argue with them. I want them to have a good life and get married and move on with their life and I see them happy in their life. 00:45:40SHARLEEN And sometimes she wants to choose our happiness for us, and that's not going to work out here. 00:45:45GONZALO BACIGALUPE Tell me how that works, I mean, you guys are -- 00:45:45SHARLEEN She wants to like choose our friends or choose where I hang out or boyfriends or husbands. 00:45:55GONZALO BACIGALUPE And she probably gave up already. 00:45:55SHARLEEN No, no. That's the thing. 00:46:00GONZALO BACIGALUPE You really think that's not the -- 00:46:00SHARLEEN No, that's the thing, she hasn't given up. 00:46:00PATTI I was supposed to.
00:46:05GONZALO BACIGALUPE She hasn't given up? 00:46:05SHARLEEN No. 00:46:05PATTI I was 14 when my parents chose my husband for me and I got married. And he was a nightmare, he was a man from hell, I think, sometimes. But I hate to say that especially in front of the boys, but he was. But the thing is sometimes I think is not fair what happened to me, I do it to them, but sometimes, I feel like if I don't get involved they don't know what to do. 00:46:30SHARLEEN She doesn't leave things alone like if the water is all calm, she has to drop a rock. She doesn't let things be. 00:46:35PATTI I see there are good looking guys, I keep telling them, look at him, he is cute, look at him, get close to him or something like that, I want them to get married. 00:46:50GONZALO BACIGALUPE But in a way you gave up the notion that you're going to have to choose. 00:46:50PATTI Not they choose, yes. 00:46:55GONZALO BACIGALUPE A boy I mean, for them? 00:46:55PATTI Choose, yes, I don't want to choose her husband. 00:46:55SHARLEEN Sometimes I feel like she suffocates us with her opinions and her thoughts and her beliefs. 00:47:05GONZALO BACIGALUPE Tell me about an opinion lately. 00:47:05SHARLEEN I mean, they are nice, but. 00:47:10GONZALO BACIGALUPE Some of the opinion that really -- 00:47:10SHARLEEN They make sense, but they make sense to you, not everybody has to go along with what you thing is the best way to do things. And she feels like, if you want to be a winner, you have to do it her way. 00:47:20GONZALO BACIGALUPE Who is the more opinionated at home? I mean, she has a strong opinion, but who else? 00:47:30SHARLEEN I think we all are that's why we don't get
along. Everybody has an input. 00:47:30GONZALO BACIGALUPE And do you have a strong opinion of how your mom should behave, do you see --? 00:47:40SHARLEEN Yeah, I just wish she should be more calm, and what just she acts, so. 00:47:40GONZALO BACIGALUPE Is there any space in this, which I mean, you did say that before that you have the dream that things were, that you were more calm, so that you could relate with her in a different level. Is there some space for her not be so calm? 00:47:55SHARLEEN I mean, her house is what she creates for herself, to be calm or not be calm right. 00:48:00PATTI Sharleen, and most of the time you guys come over there even with my bad fit dinner is ready, lunch is is ready. 00:48:10SHARLEEN Yeah. 00:48:10PATTI We sit, talk and have fun, but sometimes like well, yesterday when I asked you to spend time with me you said, not it was an argument. 00:48:15SHARLEEN I can't, I had plans. 00:48:20PATTI And most of the time they come over there and they have fun. 00:48:20GONZALO BACIGALUPE But aren't you -- 00:48:20PATTI It's not always fun. 00:48:25SHARLEEN Of course. 00:48:25GONZALO BACIGALUPE Are you willing to allow for your kids to sometimes not to respond to your demand of what you want, I mean, is there sometimes some voice in you says, you know, maybe I know I will like that, but it doesn't make sense again. 00:48:40PATTI I do. You should have seen me before. 00:48:45GONZALO BACIGALUPE Tell me about that. 00:48:45PATTI No, honest, I used to want them to be there all of the time, but not now. 00:48:50GONZALO BACIGALUPE I like your sense of humor actually.
00:48:50PATTI Thank you. No, honest I used to be to be want them to be there all of the time. 00:48:55GONZALO BACIGALUPE Ah, ha. So, now you want them sometimes, not all the time. 00:49:00PATTI Like when they moved out, the first one moved out, I want her to call every. 00:49:05GONZALO BACIGALUPE You were crazy. 00:49:05PATTI Every hour, every hour, tell me what is going on, where is she going, what's she doing and everything. Now, I changed a lot. Thanks to Sandi, I give them lots of freedom and space and I let them to choose what they should do and give them lots of freedom, don't I? 00:49:20GONZALO BACIGALUPE Have you been looking for boys for her. 00:49:25SHARLEEN Nobody remind her too. 00:49:30GONZALO BACIGALUPE Won't you remind her to look for boys for you. 00:49:30SHARLEEN Yeah, too much. 00:49:30GONZALO BACIGALUPE So sometimes, I mean, in a way you're seeing the changes, but sometimes you get as obnoxious about it. 00:49:40SHARLEEN No, sometimes I just give up on her because I feel like, I don't know how to get through her. 00:49:45GONZALO BACIGALUPE Patti, let me switch a little a bit, because she said something that you probably guys can sort of like talk and addressing therapy. If you were not having this pain and you were not having this serious difficulty to walk, which is in a way sort of like a new member in the family, I mean, is a new situation I guess for you, it was not there. How -- what would you be doing? 00:50:10PATTI I was working first of all. 00:50:10GONZALO BACIGALUPE What were you doing? 00:50:10PATTI I was caregiver and I have told you. And -- 00:50:15GONZALO BACIGALUPE Oh I'm sorry. 00:50:15PATTI I was a caregiver and I would be working 8, 12 hours a day and sometimes when I was off during the weekend I
was shopping at the mall. When I go to a store I see, for example, meat are on sale I buy them all meats whatever it's out there like, call her, I bought you meat, it's awesome, it was all sometime I get it. Do things for them all. 00:50:35SHARLEEN And that's not right, because she is not letting us grow up and have responsibility, she wants to do things, these things for us and she -- 00:50:45PATTI Who said it is not right? 00:50:45SHARLEEN She doesn't understand. 00:50:45PATTI Even if I don't call and still you come and take it from the freezer. 00:50:45SHARLEEN Mom, the thing I'm trying to -- she cooks everyday as she delivers it to my sister's food -- house everyday. I tell her let her learn on her own, you do things for yourself, go for -- don't meat stuff, go for a massage, go for this and that, clean your room if you are bored. Learn how to read and write if you are bored, do something else, stop involving your plans so much around your children, find other hobbies, find other things to entertain your life with. 00:51:15GONZALO BACIGALUPE What other things that she does for you or your siblings you will like her to continue doing? 00:51:25SHARLEEN Be the same mother that she has always been, but just not expect so much because she gives, and then, she expects so much back in return, her expectations are too high. 00:51:35GONZALO BACIGALUPE So you will like her to continue cooking and doing the things? 00:51:35SHARLEEN Once in a while. Once in -- don't make it like, it's a family ritual every week. Let it -- let us -- treat us like we have grown up and are out and doing our own life because that's how it actually is. It's just too much sometimes. I feel like, if it wasn't because of my involvement with -- so much of my energy involved with her, I would have probably take off to Europe for six months, work out there, do something, I would have a free mind to decide for myself, what to do for
like a summer time. 00:52:10GONZALO BACIGALUPE Do you have a sense that your mom may think that if she doesn't do those things, that she would be thinking that she is sort of like neglecting with you guys? 00:52:20SHARLEEN Yeah, she would feel like she has left us alone, that's just her habit or how she grew up, her mom probably that these things. 00:52:25GONZALO BACIGALUPE The time I will report her to child protector servants and doing the stuff. 00:52:30SHARLEEN I don't know about it, but she feels like she's being the best mom. 00:52:35GONZALO BACIGALUPE Are you ever thought about reporting her for, I mean for -- 00:52:35SANDI For great mom. 00:52:40GONZALO BACIGALUPE For actually, no, for letting them be their -- do their things. 00:52:45SANDI On their own. 00:52:45GONZALO BACIGALUPE Yeah. And have you thought about you could be reported, if you let them to be more independent or--? 00:52:50PATTI No, not. 00:52:50GONZALO BACIGALUPE I mean I never thought that in a way, I mean, negligence can be different. 00:52:55PATTI I'd tell they love that. 00:52:55GONZALO BACIGALUPE I was wondering if what it seems to bother you is not so much what she may do or what she may expect after she does it? 00:53:05SHARLEEN I feel like I give her an inch and then she expects a mile. I give her like, I try to please her and please her let's say, three days in a row, and she gets overexcited, then she thinks like it's a shopping for everyday. 00:53:15GONZALO BACIGALUPE What are you thinking Patti when you hear that? I mean, you are not getting angry at this point, you were so like maybe she has a point. 00:53:25PATTI No, I will call her and I leave her home, but
no. 00:53:25SHARLEEN It's really that's how she things then, then I try to -- 00:53:25PATTI I swear to god, I will not call her. 00:53:25SHARLEEN See, that's -- 00:53:30PATTI I will not contact her and just leave her alone from now. 00:53:30SHARLEEN She's. I try to explain a point to her. 00:53:35PATTI No that's not the point., 00:53:35SHARLEEN Then she feels this way, I'm here to like, you know I feel. 00:53:35PATTI I will give you the space as much as you want. 00:53:40SHARLEEN That's how she feels and I feel like sometimes she's like so in her zoom box that she's not willing to like let them down. 00:53:45PATTI As a mother, how old your kids get then you see them like they are catching the fire, you want to grab them and not let them burn theirself. 00:53:55GONZALO BACIGALUPE Your kids are going to be your kids. 00:53:55SHARLEEN Yeah, but you can't interfere. 00:53:55PATTI It doesn't matter how old they get, I want to go take them, especially because I had that abuser husband, I don't want she marry somebody abuser. 00:54:05GONZALO BACIGALUPE Let me -- we are going to have to stop very soon and I was wondering Sandi, do you sometimes, in the sessions struggle with helping them to feed out how to negotiate these things. 00:54:15SANDI I do constantly. 00:54:20GONZALO BACIGALUPE And do you have a sense that that is sort of like that the struggle is that you know the man for mom to be more balanced, less the man they know or whatever, or controlling or intuitive or whatever the way the kids may see it, or the way Patti see it as, you know, this is the way I understand being a mother and this is the way I do things and this is when I want to take care of them. How each put the
other one in sort of like a paradox, it's like, love me, don't love me kind of thing, you know. 00:55:00SANDI Right, exactly. 00:55:00GONZALO BACIGALUPE It's care for me, but don't care for me. It's how to find that. 00:55:05SANDI Right. 00:55:05GONZALO BACIGALUPE That balance I guess. 00:55:05SANDI Exactly. I have been focusing on more negotiation between them, and how they can compromise as far as what makes Patti happy and what makes the children happy. As for one big issue with Patti is the way they cloth also, the way they choose their clothing, that is another big issue. She is not happy with some of this stuff that you be talked about this before. So constantly I'm trying to balance between our way of living back home and our way of living over here, and by negotiation and compromise. 00:56:00PATTI It's mostly Shireen, the way she cloth, I don't like it at all, I cannot even stand to look at her. I will have to steal it and throw it into trash can. 00:56:10GONZALO BACIGALUPE Although, you know here you -- it's interesting because in a way here, you know in the stage you might seem like very conservative around it, but if you were to be Iran with all of the kids, you'll be considered sort of like the revolutionary and almost hang you for allowing your kids to wear the clothing they are wearing right? 00:56:25SANDI Exactly. 00:56:25GONZALO BACIGALUPE And that's that although, I don't know how -- although you are here, you saw you feel like you are there in some way, I mean, you carry your culture around is about you. 00:56:40PATTI What do you suggest for me? 00:56:45GONZALO BACIGALUPE What do I suggest for you? I don't know. 00:56:45PATTI Leave them alone. 00:56:50GONZALO BACIGALUPE You cannot leave them alone. Right. But let me -- I don't think that you can leave them
alone. 00:56:55PATTI I'll try it. 00:56:55GONZALO BACIGALUPE But at the same time, I think that you need to add another something that you need to do, I mean, I don't think that you can leave them. 00:57:05SHARLEEN Yeah, find something to do. 00:57:05GONZALO BACIGALUPE I don't know. 00:57:05SHARLEEN For real, find something to do. 00:57:10GONZALO BACIGALUPE I don't think that you can leave them alone. I think that you're still going to be concerned about them. I mean it's impossible for you, what impress me and this is something that coming to terms with what is happening to you and your body, it's not an easy task, I mean, definitely it's -- it must be really, really, really hard, and how to have other people who can be a resource. I mean, you were having that conversation right now, how you can have other people who can be resourced to help you with that, I mean, that's something that I think that should really be having conversation, the two of you. 00:57:45SANDI Yeah. 00:57:45GONZALO BACIGALUPE About what kinds of resources you can use besides you know, getting some help from your kids. I mean, because there are some things that your kids not able to do to help you with dealing with this pain and you know you were talking about your weight and how to heal this and on and on. I mean, this is sort of like a new adjustment. And before you were dealing something to happen in the past that came to visit during the present, you were happy a year and a half, you have always that sort of suddenly you were faced with this very traumatic event, series of events I, mean, what happened to you before you came here from what I understand was very traumatic. And sort of like now you are face something that is very traumatic. I mean, how do you deal with this excruciating pain, difficulty, I mean, how can you be able to walk in your own and having to -- I mean, that's -- I find it very dramatic. It's sort of like given up something, and
you cannot just run away to another culture to run away from this pain. I mean, and clearly, you're going to have to join something to be able to be aware, I mean, join, I don't know exactly what, because that's something that you probably know more about. 00:59:00SANDI We've been exploring different options as far as resources. Patti came up and you came up with weight watchers idea. And she said, that's some place I can join and it makes me feel good and I said, okay, then you are benefiting so many ways, your health, your weight and also the psychologically you are benefiting from that. 00:59:25GONZALO BACIGALUPE Hope this was somehow helpful. And we don't have more time. I'm really privileged for having you coming to the interview with someone you do not know anything about. I'm going to still thinking about this as I watch the video tape and I watch where we and I also would feel that there are things that maybe I didn't ask, but that you would have asked and I would just share them with you. Alright, because I think that you guys said so much and shared so much with us. Alright. So, thank you. 00:59:55SANDI Thank you. 00:59:55GONZALO BACIGALUPE Thank you. 01:00:00SANDI Thank you. 01:00:00Family & Sandi Return 01:00:00Epilogue 01:00:00& 01:00:00Afterthoughts 01:00:00GONZALO BACIGALUPE I'm going to comment on some themes that had to with the interview per se with the family, the reflecting team for some conceptual ideas that I think that maybe important for people to know, and also to reflect on my own thinking as I was doing the interview and also about some of the things that I may have missed after having done the interview and having seen watch the video tape a couple of times. One of the things that I did not is in the case, in the Sandi's case is how difficult it is for the reflecting
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA
1111 Student Name Albert Ramen ID 30012892 EXA

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1111 Student Name Albert Ramen ID 30012892 EXA

  • 1. 1111 Student Name: Albert Ramen ID: 30012892 EXAMPLE OF EQUIPMENT PURCHASE PROPOSAL 2 Contents EXECUTIVE SUMMARY ............................................................................................... . 3 Recommendation ............................................................................................... ............. 3 Problem ............................................................................................... ............................ 3 Benefits of the Rational Combi..................................................................................... .. 4
  • 2. Methodology ............................................................................................... .................... 4 INTRODUCTION ............................................................................................... ............... 5 Profile ............................................................................................... ............................... 5 Organizational Structure Overview ................................................................................ 5 Kitchen Operations/Equipment ....................................................................................... 5 Health and Safety Report ............................................................................................... . 5 Installation Plan ............................................................................................... ............... 6 Maintenance Plan ............................................................................................... ............. 6 COMPARISON/CONTRAST CHART of SELECTED COMBI MODELS ..................... 1 CONCLUSION ............................................................................................... .................... 1 Savings in Operation Costs ............................................................................................. 1
  • 3. Customer Satisfaction ............................................................................................... ...... 1 Recommendations ............................................................................................... ............ 2 3 March 27, 2020 To: Mr. Dalton McGinty and Mr. George Smitherman From: Albert Ramen Subject: Replacement of the Cleveland Convection Oven EXECUTIVE SUMMARY Recommendation I request you approve the release of funds for the purchase of a Rational Combi
  • 4. CPC 61, as it will greatly benefit the facility. Provided with the Combi, our foodservice department will exceed its goals of quality assurance and fiscal responsibility. Its use will capture the facility’s strategic initiatives to deliver exceptional experiences for our residents and staff. Problem Seven Oaks Long Term Care facility, located in the heart of downtown Burlington, is a one hundred-bed resident facility and community outreach center for seniors. Over the years it has set the standard in senior’s care in the community. It has consistently achieved its vision statement to deliver exceptional experiences for the residents and staff. The facility’s foodservice department’s mission is to exceed the standard in quality, and service, which of late it has struggled with. The main reason for not meeting the standard is aging equipment especially the seventeen-year-old convection oven. A recent audit of its performance indicates it is no longer financially feasible to operate and due for replacement because of: • Maintenance and Repairs Over the last two years there’s been a steady increase in maintenance repairs, which has resulted in an increase of twenty seven percent to the department. Numerous thermal
  • 5. recalibrations and most recently the replacement of the door’s spring locking system have exceeded the budget allowances. • Operation Cost Fluctuations in the oven’s cooking and holding temperatures have caused a 12% increase in food cost due to loss and spoilage. The oven’s continuous use has measurably decreased it efficiency and power conservation by thirty percent. Based on the age and the current condition of the oven, the costs of maintenance and operation will only increase with time. 4 • Customer Satisfaction Inadequate cooking and holding temperatures have resulted in poor quality products, increased resident complaints, and revenue loss. Benefits of the Rational Combi The Rational provides measurable benefits for the operator, facility, and resident. There will be immediate short-term and long-term gains for the facility. Within two years it will deliver an increase in profit and savings to pay for its original cost. The benefits are:
  • 6. • Labour Cost It will allow for a savings of .6 FTE’s per week or $ 1,460.76 dollars with an additional saving from efficient preproduction, unsupervised overnight cooking, and quick daily maintenance and service. • Food Cost It’s precise cooking technology will provide an approximate 22% percent savings in raw material and 95% in added cooking fats. • Energy Conservation the Combi’s seven different cooking modes will replace the need for multitasking and acquisition of another conventional kitchen equipment. A savings of $906.00 dollars will be gained per year in energy costs and an additional 2% per year when used continuously. • Customer Satisfaction the Combi’s seven modes of cooking applications and precise automated cooking will improve the quality and variety of food. It will minimize the chance of human error and guaranteeing the resident’s satisfaction. • Health and Safety the Combi will minimize the possibility of workplace accidents and human intervention during cooking and cleaning procedures. The automated HACCP logging system will reduce manual monitoring, recording and interpreting critical control points during cooking.
  • 7. Methodology Through benchmark comparisons and contrasts with another leading manufacture’s model the Combi was evaluated for its efficiency, ease of operation, operating costs, safety features and ability to recoup its purchase price. A plan of its quick installation and in-depth training has been detailed within the report. Its installation will minimally disrupt the residents and flow of work in the facility. The ease and safety of cleaning and maintaining its performance has been encapsulated in a maintenance plan. 5 INTRODUCTION
  • 8. Profile Seven Oaks Long Term Care Facility is a 100-bed facility and senior community outreach center. It is located in the heart of Burlington’s downtown residential community at the corners of Bayberry and Center Street. It is a religious non- medical health care facility accredited by the Ontario Ministry of Health and Long- Term Care. Founded in 1970, its one of Burlington’s oldest facilities caring for the elderly in the community. As an award-winning leader in long- term care its vision is to strive for excellence in the provision of care and services by meeting the needs and exceeding the expectations of its residents. Organizational Structure Overview The organizational framework of the Foodservice department is effectively organized with defined roles for each supervisor and their department. Christine Wellington, Foodservice Director and Chair of Operations is responsible for its operations. Stephen Field, Foodservice Manager is responsible for daily operations. Reporting to Stephen Field is his supervisory team of Janice Smith and Gordon Papers. Stephen Field is responsible for the daily activities of his department supervisors, six cooks and four dinning room attendants, and three sanitation maintenance staff. His key responsibility is in the coordination of food production, maintenance programs, health and safety.
  • 9. Kitchen Operations/Equipment The foodservice operation is responsible for providing three daily meals for its 100 residents and 60 daily meals for its cafeteria. The cafeteria provides light meals and snacks for residents, visitors and the general public. Currently, the majority of the kitchen equipment is aged being the original equipment installed. It is maintained regularly and meets Ontario Workplace Standards. The convection oven being the central piece of equipment for all food preparation is maintained although serviced continually. Upon recommendation of the facilities Health and Safety committee it has been reported for numerous health and safety infractions. Health and Safety Report The Health and Safety committee is responsible for monitoring procedures, processes, and equipment within the facility. Due to the age and condition of the convection oven two consecutive equipment audits have been completed within the last year. The oven’s safe operation is in question due to three reported health and safety incidents within the last six months.
  • 10. 6 Installation Plan The removal of the existing convection oven and pending installation of the Rational Combi will be in accordance with an installation time schedule (see appendix). The existing oven is central to the ongoing business and a necessity for the daily preparation of all hot foods. Therefore, two contingency plans have been developed to address the need for the oven during installation and any prolonged delays in its installation. During installation an alternative menu plan will alleviate any demand for the use of the oven for food preparation. The alternative menu plan will be put into effect the day of and the following day if necessary. It will utilize other pieces kitchen equipment to produce a suitable menu for the residents (see appendix). In the event of a prolonged delay in installation an emergency contingency menu plan will be activated. The emergency contingency menu plan will be in place for the duration of the installation and until it’s fully operational. Power interruptions have been accounted for during installation by careful planning prior to installation. All necessary electrical work was
  • 11. completed during the twelve days prior to installation. The power interruption the day of installation will be minimal with only a thirty-minute period of interruption. The interruption will take place after lunch service during off peak times for kitchen preparation. Maintenance Plan Maintenance for the Combi is streamlined and can be easily performed by trained facility staff. The required maintenance for the Combi has been divided into two distinct categories. One category represents the work to be completed by certified Rational technicians. The second category addresses maintenance to be performed by in house by trained staff. Rational staff will conduct the maintenance training the following day of installation. The required maintenance performed by Rational technicians is categorized by service faults indicated on the Combi’s display panel (see appendix). Rational customer service support center and local certified technicians are available seven days a week. A facility maintenance plan has been developed to include all necessary service to be performed by the facility’s authorized staff (see appendix). The facilities maintenance and kitchen staff is to be trained by Rational technicians during the
  • 12. training session as part of the purchase plan. The maintenance plan has been divided into two categories maintenance as required and daily cleaning and maintenance. 1 COMPARISON/CONTRAST CHART of SELECTED COMBI MODELS Although the Rational ClimaPlus Combi CPC 61 and Blodgett Combi BC 14E are both electric industrial combination ovens suitable for our facility’s needs and applications, they are very different models with unique features. The following is a comparison of the two Combi models. Point of Contrast Oven Model A: Rational ClimaPlus Combi CPC 61 Oven Model B: Blodgett Combi BC-14E Exterior Construction Stainless steel top, front, and sides Stainless steel top, front, and sides
  • 13. Stainless steel door, right/left hinge Stainless steel door, right hinge only Tempered viewing window Tempered viewing window Door mounted condensate trough Door mounted condensate trough Top mounted exhaust and rear external fresh air intake Side exterior exhaust and fresh air intake Interior Construction Fully welded stainless steel frame Fully welded stainless steel frame Fully insulated cooking chamber Fully insulated cooking chamber Fixed drain bottom center/back of cavity Fixed drain bottom center of cavity Self draining door drip pan Self draining door drip pan Interchangeable mobile loading rack with safety locks
  • 14. Fixed loading rack Plug in door gasket Insulated door gasket Fan wheel brake double motor Two speed fan no brake or auto shut off 2 Halogen illuminated cooking cabinet Safety illuminated cooking cabinet Dimensions Width 35.1" Depth 30.43" Height 32.75" Width 31.33" Depth 34.5" Height 33" Shipping Weight Gross 560 lbs Shipping Weight Gross 680 lbs Entry Clearances Uncrated 33" Crated 42" Uncrated 34" Crated 45" Oven Clearances Right Side 2" Left side 2" Back 2" Right Side 1" Left Side 4" Back 6" Power Supply 10KW 60HZ Three Phase 208V 28amps 10KW 60HZ Three Phase 208V 50amps
  • 15. Single Phase 208V 49amps Single Phase 208V 43amps Energy Conservation Delta T cooking standard feature with gradual temperature in cabinet Auto power shut off with opening off cabinet door. Auto power package available for continuous mode with power conservation. Auto power shut down in continuous use mode Maintain constant differential to current core temperature 1/2 power energy optimization system Energy reduced by 50% for 18KW to 9KW in optimization mode External Heat Source Proximity Minimum left side clearance 13.75" when there is heat source located on the left-hand side Minimum left side clearance 12.0" when there are sources of heat on the left-hand side
  • 16. Minimum back side clearance 4" when there are sources of heat on the right-hand side Water Supply Range 30psi - 87psi (200-600 kPa) Range 30psi - 87psi (200-600 kPa) Must maintain 30psi minimum flow pressure Must maintain 30psi minimum flow pressure Based on quality portable water only Based on quality portable water only 3 Water treatment 6-7 ph. or higher Water treatment 7 ph or higher Water supply cold water 2" diameter steam temperature resistant Water supply hot water 2" diameter steam temperature resistant On board water heater booster and non-filter system Water heater booster and filter system optional
  • 17. Water Consumption Average total water consumption 8.5 gallons per hour using combi steam option with combination heat and dry moist modes Average total water consumption 5.5 gallons per hour using combi steam option with combination heat and dry moist modes. Option is available at additional cost Values excluding usage of hand shower additional 2.0 gallons per cycle Values excluding usage of hand shower additional 2.25 gallons per cycle 3.2 gallons with dry heat and poaching feature only 2.2 gallons with dry heat and steaming feature only Ventilation Systems Steam ventilation system with automatic vapour quenching system Steam ventilation system with automatic vapour quenching system optional at additional cost Exhaust duct vented on top of unit back left/right side Exhaust duct vented on unit back left side. Clearance 4"
  • 18. Non filter system with automatic descaling of ventilation Filter system with manual descaling of ventilation Cleaning Systems Online CleanJet system fully automated Automated cleaning cycle optional at additional cost Tablet detergent system WHISM compliant Liquid detergent system WHISM compliant optional at additional cost Required 50-degree Celsius average temperature rinse Required 60-degree Celsius average temperature rinse Hand shower power wash hose Spray hose for rinse cycle hot water feed nonelectrical powered Manual clean with automated cycle Manual clean cycle Descaling automated 3 settings for continuous descale cycle Descaling automated 2 settings for continuous descale cycle
  • 19. 4 Deliming bottle and pump assembly included Deliming bottle and pump assembly included optional at additional cost 5 settings for cleaning cabinet 3 separate programs 1 setting for cabinet cleaning cycle with auto dry Computer Technology IQT technology using probe and profile logic systems Digital readout available at additional cost 7 customized setting for roasting browning Automated descaling system with auto indicators optional at additional cost Program Library containing 8 factory settings for cooking modes Delta T cooking technology for energy conservation internal probe at additional cost. CalcDiagnosis system descaling indicator IQT sensory
  • 20. technology for internal probe temperatures Delta T cooking technology for energy conservation Vario Steam technology for automated vapour quenching system IQT sensory technology for internal probe temperatures HACCP logging technology with Combi Link software Microprocessor for self cooking panel digital readouts and monitoring Vario Steam technology for automated vapour quenching system Accessories with Purchase G-N containers and grids. Chicken grids for roasting spit mode Five stainless steel wire shelves for internal cabinet locking system stationary fit
  • 21. Frying baskets. Mobile oven rack with locking safety system Locking system for rack assembly Manual cleaner and hand pressure spray gun Manual cleaner and hand pressure spray gun Hinged rack for baking Stationary rack for baking Ultra vent condensation and exhaust hood Hand shower power wash hose Accessories with Purchase Exhaust hood attachment and assembly 5 Hand shower power wash hose Optional Accessories Two step door locking system Direct steam unit available. Descaling automatic feed system
  • 22. Special voltage specifications with Single Phase feed Special voltage specifications with Single Phase feed Security version Security version Left hinge door Right hinge door only Mobile oven rack and loading with safety locking system Mobile oven rack and loading with safety locking system Optional Accessories Legs and castors with extension option Chicken Racks Legs and castors with extension option Interior Cabinet Capacity Six stainless steel wire shelves per seciton Five stainless steel wire shelves per seciton Maximum capacity 14 steam table pans 7 bake sheets Maximum capacity 12 steam table pans 5 bake sheets GN containers lengthwise loading 6 each 6 by 1 by 1
  • 23. GN containers lengthwise loading 5 each 4 by 2 by 2 HACCP Controls Continuous output of HACCP process data via unit interface Continuous output of HACCP process data via unit interface HACCP process data is stored for 14 days output via interface HACCP automated digital processor optional at additional cost Pc/Laptop optional combi link software loaded standard feature Records only on time and temperature of each cooking mode and date of each deliming cycle. Date is accessible via RS 232 serial communications via Lab top computer or PDA Health and Safety Certification S/A - NSF - and UL certified with all parts, accessories and operation systems ETL CUS, Sanitation ETL listed and CE certified with all parts, accessories and operating systems HACCP approved logging and data monitoring
  • 24. 6 ISO2000 certified Oven Mobility Optional at additional cost die-cast metal casters and adjustable legs 4", 6", 25" Optional at additional cost die-cast metal casters and adjustable legs 4", 8", 24" Extended DFG- 200 model assembly kit for stacking oven Table leg 4" mount legs standard feature with purchase Table leg 4" mount legs standard feature with purchase Locking system for metal casters Locking system for metal casters Maintenance CleanJet automated cleaning system Automated cleaning system optional at additional cost DGF Zephaire EG system compliant Manual semi automated cleaning system mode Manual semi automated cleaning system mode Hand shower power wash hose Water hose with spray nozzle
  • 25. Self drying mode Self drying mode Tablet detergent system WHISM compliant Liquid detergent system WHISM compliant Cleaning, deliming, and rinse cycle. Cleaning, deliming, and rinse cycle automated optional with purchase. Automated descaling cycle mode using CalcDiagnosis Automated descaling cycle mode BGF continuous flow cycle optional with purchase Automated steam flushing and steam generator descaling system steam generator descaling manual system Hand pump and spray bottle included for descaling semi automated system with auto rinse cycle Hand pump and spray bottle included for manual descaling Warranty One-year parts and labour One-year parts and labour Start up inspection service by factory authorized service agent Start up inspection service by factory authorized service agent
  • 26. Operational testing and installation inspection Operational testing and installation inspection 7 Onsite training by authorized Rational Canada training experts Extended two year warranty available. Onsite programming of mode cycles by training experts Technical customer service support 7 days a week. Rational chefline technical support 5 days a week North American support
  • 27. Comparison Summary of the Combi Models The Rational ClimaPlus Combi model provides exceptional benefits for the operator, facility, and resident. Rationale’s superior operating features provide optimized cost control, profit margins, safety features and resident's satisfaction. Cost Control The IQT technology precisely monitors and optimizes the cooking process to eliminate comprehensive data input such as temperature, time, and humidity. The Delta T cooking technology provides smart efficient use of energy. The microprocessor Self Cooking mode automatically detects product specific requirements and load sizes to produce consistent finished products each time. 8 Profit Return/Savings It's innovative design reduces space allocation with optimal capacity using a smaller foot print in comparison to the existing convection
  • 28. oven. The IQT technology replaces the need for all other cooking appliances such as convection ovens, ranges, steamers and deep fryers. The Combi ovens efficient operation system and built in energy conservation features provide an immediate return in savings. Safety Features The Clean Jet’s innovative circulation system ensures optimal hygiene, health protection, and reduced water consumption. The patented CalcDiagnosis system automatically monitors lime scale levels and eliminates lime buildup with no need for buying or maintaining expensive water softening equipment. The automated HACCP logging continuously records critical control point information with Combi Link transferware. The automatic logging ensures health protection and eliminates timely monitoring, recording, and manual interpretation. Resident Satisfaction The digital microprocessor uses one control to provide seven different cooking modes. The different cooking modes provide limitless culinary variety. The Self Cooking technology eliminates flavour and odour transfer, even when there are different products
  • 29. cooked at the same time. The nutritional value in foods is preserved ensuring the retention of vitamins and minerals. The outstanding consistency along with optimal quality cooked food will inspire the resident's confidence and satisfaction day after day. Challenges The Rational combi involves a more complex lengthy installation and training period in comparison to the other model. Although over the long term the costs for installation and training will be returned in profit savings. The operation of the Rational model is easy although it involves a more complicated lengthy training program for the kitchen staff. The intensive training program is included in the purchase. The trained will ensure its performance and maintenance is optimized. The cost of cleaning and descaling chemicals will increase budget allowances although the labour costs wil l counterbalance the offset in costs. 1 CONCLUSION Based on a benchmark comparison and contrast of features of
  • 30. the two Combi models, an evaluation of installation and maintenance costs, and safety operating features, the following conclusions can be drawn. The Rational model provides measurable benefits for the operator, facility, and residents. Immediate short-term and long-term gains for the facility will be maximized in acquiring this piece of equipment as follows: Savings in Operation Costs The Combi will provide immediate short-term monetary savings in operations costs. Over the long-term it will deliver increased profit margins with a return in savings paying for its original cost. The Combi will provide a return in savings to pay for the purchase price in twenty months (see appendix). • Labour Cost The labour cost will be reduced immediately by utilizing the Self cooking microprocessor feature, which automates the cooking process and optimizes capacity of output in preparation. It will allow for a savings of .6 FTE’s per week or $1,460.76 dollars a month (see appendix). • Food Cost The food cost will be reduced by the Combi’s efficiency in yield results with IQT technology. An approximate 22% savings in raw material and 95% savings in fats and oils used in the
  • 31. cooking process (see appendix). Its precision cooking technology will reduce waste due to improper cooking and human error. • Energy Conservation Conservation mechanisms will reduce cost by compensating energy usage by reducing power to complete the cooking and holding time and temperatures. A savings of $906.00 dollars per year in energy costs will be saved (see appendix). Its energy features control the use of energy during peak loads and continuous operation to provide an additional 2% savings per year • Equipment Expenditures Expenditures will be dramatically reduced in the immediate and long-term. The Combi’s seven different cooking modes replace the need for acquisition of other conventional cooking appliances such as convection ovens, ranges, deep fryers, and steamers. Customer Satisfaction The quality of the food and resident’s satisfaction will be immediately improved with the use of the Combi. It provides seven distinct cooking modes to increase more options in methods preparations and styles of cooking. This is an improvement to the limits of the current equipment. The model’s IQT sensor technology will provide a consistent custom finished product, which will assist in standardizing resident’s preferences
  • 32. 2 Most importantly the Combi will eliminate the possibility of health and safety incidents. Its automated self-contained maintenance features and built in safety mechanisms minimize human intervention during the cooking and cleaning process. The CleanJet and CalcDiagnosis cleaning systems reduce the possibility of human error and accidents. The automated HACCP logging system reduces manual monitoring, recording, and interpreting time and temperature data. Recommendations The mission statement for the foodservice department is to deliver exceptional experiences with exceptional people, product, and service. Provided the Rational Combi the department can both achieve the department’s mission and deliver the goals of the facility’s strategic plans. In creating exceptional experiences for our residents and staff we may optimize profits, operating cost, and health and safety procedures. Based on the above benefits it would be advantageous to approve the purchase of the Rational Combi model.
  • 33. NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Template Week (enter week #): (Enter assignment title) Student Name College of Nursing-PMHNP, Walden University NRNP 6635: Psychopathology and Diagnostic Reasoning Faculty Name Assignment Due Date Subjective: CC (chief complaint): HPI: (include psychiatric ROS rule out) Past Psychiatric History: · General Statement: · Caregivers (if applicable): · Hospitalizations: · Medication trials: · Psychotherapy or Previous Psychiatric Diagnosis: Substance Current Use and History: Family Psychiatric/Substance Use History: Psychosocial History: Medical History: · Current Medications: · Allergies:
  • 34. · Reproductive Hx: Objective: Diagnostic results: Assessment: Mental Status Examination: Differential Diagnoses: Reflections: Case Formulation and Treatment Plan: References © 2021 Walden University Page 2 of 3 NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Template INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.
  • 35. In the Subjective section, provide: · Chief complaint · History of present illness (HPI) · Past psychiatric history · Medication trials and current medications · Psychotherapy or previous psychiatric diagnosis · Pertinent substance use, family psychiatric/substance use, social, and medical history · Allergies · ROS · Read rating descriptions to see the grading standards! In the Objective section, provide: · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses. · Read rating descriptions to see the grading standards! In the Assessment section, provide: · Results of the mental status examination, presented in paragraph form. · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5
  • 36. diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. · Read rating descriptions to see the grading standards! Reflect on this case. Include what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). (The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.) EXEMPLAR BEGINS HERE CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why they are presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member. HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication, and referral reason. For example:
  • 37. N.M. is a 34-year-old Asian male who presents for psychotherapeutic evaluation for anxiety. He is currently prescribed sertraline by (?) which he finds ineffective. His PCP referred him for evaluation and treatment. Or P.H. is a 16-year-old Hispanic female who presents for psychotherapeutic evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her mental health provider for evaluation and treatment. Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, the duration, the frequency, the severity, and the impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders. You will complete a psychiatric ROS to rule out other psychiatric illnesses. Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13. Caregivers are listed if applicable.
  • 38. Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors? Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it) Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. (Or, you could document both.) Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures. Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information (be sure to include a reader’s key to your genogram) or write up in narrative form. Psychosocial History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:
  • 39. · Where patient was born, who raised the patient · Number of brothers/sisters (what order is the patient within siblings) · Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children? · Educational Level · Hobbies · Work History: currently working/profession, disabled, unemployed, retired? · Legal history: past hx, any current issues? · Trauma history: Any childhood or adult history of trauma? · Violence Hx:Concern or issues about safety (personal, home, community, sexual (current & historical) Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries. Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products. Allergies:Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance. Reproductive Hx:Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns
  • 40. Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines). Assessment Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudo hallucinations, illusions, etc.), cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form. He is an 8 yo African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinki ng. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good. Differential Diagnoses:You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case. Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s treatment of the patient and why or why not. What did you learn
  • 41. from this case? What would you do differently? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). Case Formulation and Treatment Plan. Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions with psychotherapy, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. *see an example below—you will modify to your practice so there may be information excluded/included—what does your preceptor document? Example: Initiation of (what form/type) of individual, group, or family psychotherapy and frequency. Documentation of any resources you provide for patient education or coping/relaxation skills, homework for next appointment. Client has emergency numbers: Emergency Services 911, the Client's Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them) Reviewed hospital records/therapist records for collaborative information; Reviewed PCP report (only if actually available) Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment
  • 42. regimen as discussed. (This relates to informed consent; you will need to assess their understanding and agreement.) Follow up with PCP as needed and/or for: Write out what psychotherapy testing or screening ordered/conducted, rationale for ordering Any other community or provider referrals Return to clinic: Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care OR if one-time evaluation, say so and any other follow up plans. References (move to begin on next page) You are required to include at least three evidence-based, peer- reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. © 2021 Walden University Page 1 of 6 A MOTHER and A DAUGHTER: 00:00:35A CULTURAL TALE 00:00:35AN INTERVIEW WITH 00:00:35GONZALO BACIGALUPE, PhD 00:00:35Produced by 00:00:35Andrews & Clark
  • 43. 00:00:35Explorations, Inc. 00:00:35copyright 2003 00:00:35GONZALO BACIGALUPE When I'm asked to do a consultation, one of the first things I ask is, what will be the most benefit for the client and the therapist and in the case that you're going to see I'm basically asked to have a reflecting team and what we did was first have an interview with the therapist and the family and ask them what they will find useful for the interview and basically to ask them about the history of the therapy and the history of what are the kinds of things that they have been working on. I ask the reflecting team to come in and I instructed them to think of themselves as so let the god mothers of the therapist, who in a way, put them, himself, or in this case herself at risk in front of her peers and another people. So, I wanted them, the reflecting team to address the therapeutic system as a whole not just to address the family, I wanted them to talk also about the therapist and to be protective of them. I also ask the reflecting team not to be too much of clinician, but to really react on a more personal level around the family. I sometimes reflected on what they were saying to clarify or to expand the idea or how I understood it to give voice to other possibilities, but respecting the personal peace, and then, I ask I ask the family to come back to, in a classical way, to respond to those comments what strike them. In the case that we watch, it seems that the family was dealing with sort of like two forms of trauma and/or three forms of trauma; one is, history of battering the domestic violence, child sexual abuse, a history of immigration that in some ways we lay it to that trauma getting away from it and basically the mother of five children deciding that they need to move out of the home, but in the process leaving one behind who is later on sexually, I mean, raped by the father. And then at the present moment mother dealing with a fairly traumatic illness that have her, very disable, unable to walk and to work. So, it's sort of like the interview trying to address this different forms of trauma and the way in which the young adults are trying to
  • 44. make sense of their bicultural life and how the whole family is trying to make sense of being bicultural and being immigrants. The session doesn't end with a need or incredible intervention of my part because I feel that this is the part of the therapist to try to decide, this is the family that's been working this therapist for year and half. Therefore, they have a relationship I feel that I need to respect and so those are the basic intercomments. So tell me how is it that you came out with the idea of having this interview with me? 00:04:30Sharleen 00:04:30Patti 00:04:30SANDI Okay. I'm going to go back when Patti came in for the first time. She came in because they were chaos at her household. 00:04:45Sandi - their therapist 00:04:45SANDI She came to this country twelve years ago with her four children and one was left behind, her daughter who was 10 years old at that time, eight years old at that time, was left behind. Just two years back, finally they were able to get her visa and she brought her to United States. So ever since she came here chaos was created inside the household. 00:05:20GONZALO BACIGALUPE So I'm clear, Sharleen you are? 00:05:25SHARLEEN Her daughter. 00:05:25GONZALO BACIGALUPE Her daughter. And how old are you? 00:05:25SHARLEEN I'm 23. 00:05:25GONZALO BACIGALUPE 23, and how old are your siblings? 00:05:30SHARLEEN 24. 00:05:30GONZALO BACIGALUPE And that's sister or brother? 00:05:35PATTI Sister. 00:05:35SHARLEEN And then 21-year old sister and 18-year old brother and a 15-year old brother. 00:05:50GONZALO BACIGALUPE Okay, and which one is the
  • 45. one that stayed there. 00:05:50SHARLEEN 21. 00:05:50SANDI 21. 00:05:50GONZALO BACIGALUPE 21. Okay. All right. Okay. Go ahead, sorry. 00:05:55SANDI And I met with the entire family for two couple of sessions and she really interested and wanted to be in therapy 21, so. 00:06:10GONZALO BACIGALUPE What's her name? 00:06:10SANDI Shireen. 00:06:15Shireen - the 21 year old sister 00:06:15emigrated from Iran 2 years ago 00:06:15GONZALO BACIGALUPE Okay. 00:06:15SANDI She just felt that she needed the money more than coming to therapy and she refused the entire time and mom tried to she ask her, if she doesn't feel comfortable with me. She said she has had all appointments with other therapists at this clinic, still she refused to come in, but they kept on seeing Patti and the oldest daughter Sheela for about a year and a half now. Ever since then, we started working on the chaos in the household, what is it that creating chaos and I found out that Patti lives with traditional ways of living, their daughters are trying to detach herself from Patti and grow on their own and find their own individuality. So would ask where they have been working on and every since then she had two surgeries. 00:07:30Patti had surgery on both feet. 00:07:30SANDI Every thing is started. 00:07:35GONZALO BACIGALUPE Who had two surgeries? 00:07:35SANDI Patti had two surgeries on her feet. 00:07:40Surgery failed - she is disabled. 00:07:40SANDI And that created more tension, anxiety in the family. 00:07:50She is in constant pain. 00:07:50SANDI So -- and I have been seeing her after her surgery and she has been referred to a psychiatrist for medication because a lot of time she feels hopeless, helpless,
  • 46. she feels her children are out of control, she can't be in charge, they no need her anymore. So those are the major. 00:08:20GONZALO BACIGALUPE If you were to describe an accomplishment and you have accomplishment with the therapists during this time. Is there something that you will say, it's an important accomplishment? 00:08:35SANDI Awareness of the difference between individualist ways of living and collectivistic ways of living and awareness that how they to respect and understand the children are growing in this country and they are going to try to detach themselves from Patti to be able to grow on their own. 00:09:00GONZALO BACIGALUPE What has been for you this work with Sandi? 00:09:05PATTI She helped me to understand the kids grow up and left the house and they have been not to depend on them so many times and try to live my life alone and then to take care of my things, my problem in the life and respect them and give them their freedom. 00:09:30GONZALO BACIGALUPE Do you have a sense that that is sort word that has been accomplished that is more to be done. 00:09:35PATTI I think I need more to be done, I'm not done. No. 00:09:40GONZALO BACIGALUPE Do you have of sense of what is that you would like to do? 00:09:45PATTI Yeah, I'd like to learn to lead my life alone and depend on the kids a lot because in our custom when the parents get old and especially when they are in my situation they can't walk or take care of theirself, the kids are always there for parents, but over here no, they have their own life. And I expect them to be there all of the time for me and they can't, matter of fact, I had a big argument with her last night about that, I had a very bad back for few days I was done and last night, I called her and I said come and spend a night with me and she said no, I can't. I said, you should and you have to and we got into a
  • 47. big argument. 00:10:30GONZALO BACIGALUPE So, you are on your own right now, you're living in your own and each of the kids have their own place or? 00:10:35PATTI Three of them, two of the boys lived with me 18 and 15 years old, but the 15 years old was with her for three four days and I was with 18 years old a lot. I feel like they doesn't do enough for me. 00:10:50SHARLEEN She makes her own plans for me, she expects me to like to go with her and spend time with her because she is bored. I have too much to do, I can't unwind your boredness, find something else to do, but I have plans, I'm 24 and my world around me is happening and I need to be there, I accomplish things. I can't sit down and like chitchat for a whole day. 00:11:15PATTI And I feel I'm depressed I cannot move, I need them to come and visit me, spend a night with me. 00:11:20SHARLEEN I spend, I -- out of the seven days, I saw her for six days, I make sure, I saw her for six days out of that week. I spent a day with a friend and I got some stuff done and she felt like I owe her something because I didn't spend that time with her. And she did a nice job raising us, she was a wonderful mother, we all suffered through the good and the bad in the family like every family does, but we have all grown up, we can't stay in the nest forever. I'm trying to experience life and my own good or bad, whether you approve it or not, it's my life. 00:11:55GONZALO BACIGALUPE Sharleen, is this something that you have had a discussion, the three of you, I mean this particular or this is not like? 00:12:00SHARLEEN I think, I have mentioned to her, but she takes it personal, she doesn't hear me out. 00:12:05GONZALO BACIGALUPE Is this something that you have had conversations with the family? 00:12:10SANDI Over and over, yes. Especially with the oldest daughter Sheela, she also, being the oldest, she feels that she
  • 48. has been the parentified child all her life, she has played a role of a man for -- in her mother's life and then the entire, I've seen her for about four times right, four, five times and she used to cry the entire time in the session. 00:12:40GONZALO BACIGALUPE And I realize that you're being very touched by this, I mean this is not something that. 00:12:45SHARLEEN Yeah, it's something that I strive so hard to accomplish and as soon as I feel like I got her on the right step, there she goes falling depart again asking for like, I give her what I can and she keeps on asking for more and more and that's not how my life works. 00:13:05GONZALO BACIGALUPE What do you right now? Are you working, studying? 00:13:05SHARLEEN Yeah, I work and I'm trying to get my license. I'm trying to get accomplish things from now. 00:13:15GONZALO BACIGALUPE What kind of work are you are doing right now? 00:13:15SHARLEEN I just -- I find promotional jobs and then, I'm trying to get my real estate license. 00:13:25GONZALO BACIGALUPE And your sister? 00:13:30SHARLEEN Sheela? 00:13:30GONZALO BACIGALUPE Sheela, is she also on her own? 00:13:30SHARLEEN Yeah. 00:13:30GONZALO BACIGALUPE She is also working, studying? And the 18-year old, what is he doing? 00:13:35PATTI He is a student. 00:13:40GONZALO BACIGALUPE In high school? 00:13:40PATTI Yes. 00:13:40GONZALO BACIGALUPE So, he is finishing high school right now? 00:13:40PATTI Yes, this year. 00:13:45GONZALO BACIGALUPE And is he talking also about leaving home after finishing the high school or what are his plans? 00:13:50SHARLEEN He is not sure yet, depends on how the
  • 49. family situation is going, you know, everybody looks for happiness and peace of mind, depends like how he feels around the home. 00:14:00GONZALO BACIGALUPE How about the 15-year old? 00:14:00PATTI I have lots of problems with him, I don't get long with him at all. 00:14:05SHARLEEN She has no patience. And she takes it out on other people. 00:14:10PATTI Because I can't do anything, I walk fewer step and that's it, I have a horrible pain after fewer step. And I have to sit and wait for them to come and give me a glass of water. 00:14:25SHARLEEN Well, the thing is I want her not to wait for us, I want her to be on her own, I want her to learn how to like, you know there is a -- you know superman lost his both feet and he sits on a wheel chair, but he is still going on with life. 00:14:40PATTI But Superman has money, somebody take care of him all of the time. 00:14:40SHARLEEN You have to learn how to ease your own mind and not depend on other people. She is forty years old, if she was 60, poor dying lady, I would be more sympathetic, just 40 years old, there is much more for her to experience. It's not time for her to start depending on her children yet. We're only in our 20s, let me live life, let me experience and do what you can, while you can. Give it your best. 00:15:10GONZALO BACIGALUPE Sharleen, how is that you decided to come today, I mean what's it? 00:15:10SHARLEEN Because I was with her last week and they asked me to, they invited me to, so I thought maybe you would like help as much as this is helping you. 00:15:20GONZALO BACIGALUPE Do you have a sense that you are sort of being representative of the other of your siblings that you are coming as a representative for all of them in some way?
  • 50. 00:15:30SHARLEEN We are all trying to get her to be more positive and feel like do a little step at a day, but try your best to be better, to do a better in life. Every time I try to push her to be more independent and not as much like do that all stuff with her that she could do on her own, she keeps like she has a broken wing that she wants to buoy on us, after a while, it gets heavy. You just want it off because I want to breathe and I want to experience my life. I cannot live like a 20-year old from Iran. I have different things to experience than to sit at home. And the thing is like I don't feel like I can accomplish with her when I'm at home because she is either watching TV or on the phone, which is just like sad people around and I can't hang out like that. 00:16:20GONZALO BACIGALUPE Besides the -- your five kids and yourself, is there anybody else in the family here who immigrated with you guys or --? 00:16:25PATTI I have a cousin, but they live LA and I don't even talk to them. 00:16:35GONZALO BACIGALUPE And so, in a way, when you need something, basically the only thing that you feel like you can go for your kids? When you -- we're talking about chaos, there have been -- there were some chaos about a year and half ago when we start through the work and can you tell me little bit about what the chaos was about or what -- how you define that? 00:17:00SANDI Okay. I just want to mention something about before her surgery Patti has been a very independent women as far as working hard, single mother, raising all her children and they are all proud of her in many ways. When they came she did not have the health problem as far as the pain in her feet, constant pain and feeling hopeless and helpless. They came for a different reason was for Shireen, because Shireen came form Iran and two weeks everything was wonderful, they all re-united, they enjoyed, celebrated for two weeks, and then, she started telling him about the stories that her father abused her sexually, physically and she was
  • 51. abandoned in their house. So, that's where the explosion, the chaos started. Before that -- 00:18:05GONZALO BACIGALUPE When you say that the chaos started, what started to happen? 00:18:05SANDI They were fighting, constant fighting, screaming, yelling and cursing each other. Before that, my understanding was that kind of was a very peaceful way of living, am I correct in this? 00:18:25GONZALO BACIGALUPE Okay. All right, so the tension has really sky rocketed after Sheela came back, I mean, two weeks after one, and then, he came out of that -- there's been this --? 00:18:35PATTI As she came back, she was blaming me, why did you left me back home with my dad there, he did all of those things to me. And my husband used to tell her, you was a rotten fruit and she didn't take you, you are a rotten one. She took the good ones and left you behind for me. And she was blaming me for everything. 00:18:55GONZALO BACIGALUPE When you left, you had separated from your husband? 00:19:00PATTI No, we were living together my daughter had a medical problem, Sheela and matter of fact, her, and they give me a medical visa to come here and Sheela and Sharleen born here many years ago. And when I went to get a Visa, they told me two of them are American citizen, you have to take them, we cannot say no. And my boys were four years old then 18 months old and Shireen was eight and they said, they decide Shireen should be stayed home and make it sure I'll will be go back. But after I came here, my daughter didn't have any problem any more and they were find and I used to stay here and I decided to live here. And my husband was keep telling me don't come, don't come, stay there, I will come some day and he never sent me any money, he never did anything for us at all except sending the letter 10 pages every single day, what to do, how to leave and how to raise the kids and I throw them all in the trash because I didn't had a time to read them and I didn't had time to
  • 52. practice anything he said and I ignored everything until like six, seven years later, he just wrote a letter, I want you to be back home, you are my wife, I order you to back home and I said, forget about you, I have my life here. And who wants to go back to that life. And I was thrown all of the time to bring Shireen and I couldn't until three years ago. Finally, she came and for couple of days, weeks everything was fine until she started talking about every problem she had back home and for any little mistakes she made, my husband used to beat her up and keep her outside the house for all night and many, many things, the things he used to do to me. And I know what she talking about and what she had to go through, but I couldn't do anything about it. I didn't have the choice. When I came here few week after, few months after I was here I called my dad and I said, I'm worried about Shireen, I afraid to beat her and I'm not there to protect them because I was all this over to protect the kids. Each time he wants to beat them, I was right ahead of them and say, beat me, don't touch my kids, do whatever you want with me. And my dad said you should imagine your house was in the fire, you took four of them off the fire, you left one behind, leave her behind and take care of those four you have and I thought about it, I thought, he is very right, absolutely right, I should take care of the four I have over here. Why should I go back there. He would be -- make everybody miserable. I didn't have a very good life but like she said, we all worked together and take care of each other and like I was out all of the time and like Sheela said, she was father of the kid, take care of the kids, take care of the bank account, his groceries, everything. And I used to be a care giver and save it all this and Sheela and Sharleen would stay home and take care of the kids, two younger brother and each other. And everything was okay until Shireen came. And then, after few months, for a couple of years, we had a problem until, thanks god, last May she got married with somebody behind our back. 00:22:25GONZALO BACIGALUPE Who got married?
  • 53. 00:22:25PATTI Shireen, we were on the camping three when she ran away with one of my friend's son and got married and she moved out the house and my house is so quiet and I enjoy the life so much except I get so depressed because I feel hopeless and I have so much pain and they can't do anything about my pain, I'm always in pain. 00:22:50GONZALO BACIGALUPE As you must have seen, when -- do you work on how they make sense of what happen to Shireen, I mean, in Iran during the time that she was alone, was that workout with the whole family, they were some sort of a conversation in therapy? 00:23:05SANDI Yes, I met, as I remember, I met with all of them and they expressed their feelings and shouting, yelling, everything was going on in our session. And they were expressing, Shireen was constantly blaming the mother for all her pain and what happened to her to lead on and a mother tried to explain her situation, the sisters also, brothers also. So, we had few sessions like that. 00:23:35GONZALO BACIGALUPE What was your sense of how it can -- that there were some sort a resolution around that that people were able to make sense that Patti and the kids were able to make sense of this or? 00:23:50SANDI I was hoping for that, that was my really aim to discover, explore their meanings of the situation and. 00:24:00PATTI They got in fight, we couldn't keep coming back, I couldn't make them to go back as a family. 00:24:05GONZALO BACIGALUPE Is it still something that is very hard to talk about or not? 00:24:10PATTI About the rape you mean? 00:24:10GONZALO BACIGALUPE Yeah? 00:24:10PATTI What do you think? 00:24:15SHARLEEN Well, I'm not very worried about, I mean, it's affecting her life and I feel sorry for her, but I try not to think about it. 00:24:25GONZALO BACIGALUPE And do you have the sense that that's what anybody else in the family tries to do that tries
  • 54. hard so they doesn't affect? 00:24:30SHARLEEN Because we already did our crying over it and I'm over it, I'm ready to move on about it. 00:24:40PATTI It's like when somebody die, you grieve for it. When I heard about it, I was crying and crying and crying for months and months, and then later on, it's something you can't do any thing about this, something happened, what am I going to do about it. I tried to take her to counseling, I take her to Iranian psychologist, 200 dollars an hour. And she would then go back, then what can I do. And I think I'm over with it, I feel sorry for her, but what can I do. My older son doesn't want to talk to this, his dad, nobody wants to contact him or have any relationship or any thing to -- 00:25:20GONZALO BACIGALUPE Has he acknowledged that he did rape her? 00:25:25PATTI I told him once, and he will start cursing at me and I hang up. I said, I pay a dollar fifty a minute, I don't want to hear your cursing. I want to see what's going on, what happened and you tell me if it happened or not and will start cursing and I hang up. And after that, I never called back, and he is remarried, he married to Iris after Shireen came, during the three years, he got married twice and he has moved on with his life. 00:25:55GONZALO BACIGALUPE Is there any, I mean, is there a way in which you think, I mean you, Sharleen and maybe some of your siblings, but just from your perspective, is there where you think about how the relationship with your mom should be, is it -- do you have a dream for how? 00:26:15SHARLEEN Yeah, I just wanted her to be more peaceful. I want her to lower her expectations and to accept a lot of things about life. 00:26:25GONZALO BACIGALUPE What do you mean lower expectations, what? 00:26:25SHARLEEN Not to expect so much from people, not to -- I think what she does is, she thinks of an idea and she reacts on it so so quick without she calming herself down before she
  • 55. like takes the reaction. 00:26:40GONZALO BACIGALUPE Do you have a sense that your mom thinks that you can do more than what you can actually do? 00:26:45SHARLEEN I have a sense that she is holding me back from doing all that I could be doing and as soon as I could get excited about her, every time I give her little bit of hope, there she goes back expecting more, and then, getting angry at. She has some thoughts then she is so hang up that these thoughts are like so true and she gets angry about them and she hold on to them, then she accuses people and all they are her thoughts in her mind. And I just ask her to leave them alone, let people be and everything is going to -- just then it's going to take its course. 00:27:15GONZALO BACIGALUPE Am I trying to tell you, if you were to think about how your ambition, how you see it in the future, the relation how do you see it? I mean, if you were to move in a way the direction that you want it to move, how many times do you see yourself beside in her or interacting with her? 00:27:35SHARLEEN I speak to her every day, I mean almost everyday. 00:27:40GONZALO BACIGALUPE But again, I'm asking you more about -- 00:27:40SHARLEEN Like in the future, yeah, I just want her to like be more calm about like life so that I could like through her better. So that when I do spend time with her that I could enjoy it better instead of her frightening my other siblings or telling me about how so and so, this and that and this and that. I just want her to be more calm so we could just enjoy the moment when we hang out, rather than like. 00:28:05GONZALO BACIGALUPE What kinds of things do you enjoy with her in the moment? 00:28:10SHARLEEN I try to tell her about my ideas, how she is like be more relaxed and not -- you know same things. 00:28:15GONZALO BACIGALUPE Patti, how do you ambition
  • 56. the relationship with your daughter? 00:28:20PATTI I saw her on Sunday, Sunday night and Sunday night, I went to visit my older daughter and she was aware that I took the dinner for them. And after I laid down fully at my daughter, older daughter house, I couldn't get up, they pulled me and took me to the car and I came home. I didn't see her until yesterday afternoon and I said, I have been done with my bag. I just want them to spend time with me. I'm lonely, I get depressed when I'm lonely. If she had a job, if she was working like the other people, I would understand she is working everyday like my older daughter, she go to her school, she work, I understand she doesn't have a time, but I know she has time and I expect her to come and spend the time. And I said, I gave you whatever you want, whatever I have in the house like furniture, this and that, anything she said, mom can I have this? Sure, honey, doesn't matter you or me, you can have it. And when I'm like that with you, I expect you to do something for me too. 00:29:20GONZALO BACIGALUPE Patti, I understand how also you are feeling upset about this, about and I know that the question I'm asking is hard, I mean, how do ambition the relationship with Sharleen? What will you like to happen in the future? 00:29:40PATTI Between me and her? I want her to just spend time with me whenever she can. 00:29:45GONZALO BACIGALUPE What kind of time for instance would you like to --? 00:29:45PATTI She come and stay at my house because she knows I cannot live with two boys and go to her house. She most of the time ask me to come and stay at my house, but when I go to her house and I spend over there, I'm worried about 18 years old I have at home. 00:30:05GONZALO BACIGALUPE And do you have a sense of how many times, how many nights that you would like her to spend with you in your home? 00:30:10PATTI Once a week is good if she come and stay the
  • 57. day or night, once a week with me is fine, but when she come like one hour, half hour, she is for example, going to go see so and so to keep a board work, she will stop at my house to have a drink the water or say, hi mother, how are you? 00:30:30SHARLEEN Two, three hours? 00:30:30PATTI That's not a visit for me, I wanted to come with me and spend the time with me and stay with me that day. 00:30:35SHARLEEN When I go over there, she is either on the phone or she is watching TV, I'm very, very uncomfortable in her house like to where I cannot stand sitting down because she has two dogs around and I don't like those things. I don't like the hair on my body. When I touch an animal, I wash my hands before I eat. She has two dogs, there is dog here on the couch, dog here on the floor, dog here on the chairs, there is dogs all around. I don't want to eat anything because the dishes smell like dogs, I'm not comfortable. I don't enjoy that, it's not pleasant to me. I could only do it so much at a time. I express that to her, you have dogs, I can't eat either your dishes. That's my culture, that's how I was brought up and I thought that's how she was brought up. So, she surprises me when she does these things, she makes the family unhappy because nobody wants to see dogs, it smells like dogs in her house. 00:31:25PATTI How come you don't do the other things, you grow up and have a cold chill like, that's just the only thing you know. 00:31:35SHARLEEN I don't -- I cannot stand it, I cannot stand it. 00:31:35PATTI And they give me so much happiness, they make me so happy, I love them so much. 00:31:40SHARLEEN I don't like it. 00:31:40PATTI And I never ever going to get rid of them. 00:31:45SHARLEEN I don't like it, don't ask me to sleep in the pillow, it's that the dogs stinks. 00:31:45PATTI Actually, you know we have a guest room, the dogs doesn't in that room. 00:31:50SHARLEEN I cannot sleep in motels, I cannot
  • 58. use other people's bed, I cannot sleep with dogs, I cannot do these things. 00:31:55PATTI You know that bed brand new and you know the sheets and everything brand new in the guest room and you know that that door is closed. 00:32:05SHARLEEN I'm not enjoying it, I cannot eat breakfast, when I'm thirsty I can't drink water there. 00:32:05GONZALO BACIGALUPE Let me ask you, is this the kind of sometimes the -- where the discussions go? 00:32:10SHARLEEN Yeah. 00:32:10GONZALO BACIGA And if I were to let you go over the discussion where will it end, one of you will leave the room or --? 00:32:20SHARLEEN I will start screaming. 00:32:20PATTI Screaming, yeah. 00:32:20SHARLEEN And disrespecting and calling names. 00:32:25PATTI I do. 00:32:25SHARLEEN At this stage, I don't -- 00:32:25GONZALO BACIGALUPE And you would be like, I don't want to see you, I don't want to talk to you anymore. 00:32:30SHARLEEN I'm trying to become a woman, I'm trying to became a lady. And when I go to her house, she treats me disrespectfully like that about her dogs, she would curse me out and I just feel, oh, what a mother. 00:32:40GONZALO BACIGALUPE Would you say both of you that you would like that not to happen that you will not get into this. 00:32:45PATTI Of course I love them. 00:32:50GONZALO BACIGALUPE Do you sometimes dream with, been able to relate to each other without having to get into this. 00:32:55SHARLEEN Of course, I do. 00:33:00PATTI I feel even we argue, we still love each other and I feel like, they are my kids, they will be still here for me if I need them really. And they have been until sometimes lately. 00:33:10SHARLEEN I just want her to appreciate and not to
  • 59. expect and expect just like take what people give you and just be happy. 00:33:20GONZALO BACIGALUPE We're going to stop a little bit now. 00:33:25Reflecting Team Enters 00:33:25Isaac 00:33:25ISAAC I'm Isaac and I really resonated with Sharleen. I come from, well my parents emigrated here. 00:33:40GONZALO BACIGALUPE Where your parents came from? 00:33:40ISAAC Korea, and I was born in the States, but there are still this cultural tension that we experienced within our family. And so when she was talking about the difference of cultures and who she is and there was a little bit of disparity between her Iranian culture and the American cultures in her life and I experienced that in my life too. So, I really understood that and I thought, you know what? I'm not the only one that went through that. And if I'm not the only one then she is not the only one either, so something that I guess happens in a culture of people when they immigrate into another country. 00:34:30GONZALO BACIGALUPE How old were you when you immigrated? 00:34:30ISAAC I was born here. 00:34:30GONZALO BACIGALUPE You were born here, but still -- 00:34:35ISAAC My parents, my parents moved here. When they were in their mid-20s, they moved here. And then I was born and shortly after they moved here. And so there was a been influence there. 00:34:50GONZALO BACIGALUPE All right, cool. 00:34:50Roberta 00:34:50ROBERTA My name is Roberta and these things really struck out with me because I have seen Patti before. I have been on the reflecting team. And I'm amazed at the difference in her, how much younger she looks and more vibrant than the last month I had seen her. So, I was very impressed by her change.
  • 60. Another thing that just really struck out from me was when Sharleen was talking about what she didn't want to do, and then, Patti talked about when her husband had sent her the letters and said, come home and Patti didn't want to go home and it was almost like it was the same conversation, only held with different people. And I thought that was rather interesting that they are both having the same things happen in their life at different times, but they both wanted their independence. And I saw that realistic out from me, so that was very interesting. 00:35:45GONZALO BACIGALUPE Yeah, it's interesting, I was -- I don't know if it's the same you are saying, but how can you have your independence, but at the same time, still stay connected? It's a hard one. 00:35:55ROBERTA And they are fighting to stay connected. 00:36:00Dorothy 00:36:00DOROTHY First of all, I'm really impressed with Sandi, the therapist and working with this family and having the care and the love that it concerns between all of them, including Sandi as a therapist. And I really relate it to Patti because I have six children and I watched them one leave one at a time and so I know what that feels like. 00:36:25GONZALO BACIGALUPE What it feels like? 00:36:25DOROTHY Well, it is -- it feels like a tragedy really each time. There is always, there's something to deal with because it's a grieving, you are letting go. You are letting go and I really relate it to her on that level, completely, but I didn't have the kind of real tragedies to deal with that Patti has had to deal with, in addition to this letting go, okay. She has had the, well, the disability to deal with in the pain, the constant pain that she deals with and also then the tragedy in her daughter's life and what must come up for a mother in dealing with that. I mean, unavoidable in the situation, of course, but still she was dealing with that. At the same time, with all of this other emotional stuff that I know about. So, I just have a lot of respect for her and I noticed that she has done a good job with her children. How wise Sharleen is for a age, very wise, so.
  • 61. 00:37:35GONZALO BACIGALUPE In a way, Roberta? 00:37:40DOROTHY Dorothy. 00:37:40GONZALO BACIGALUPE Dorothy, in a way it is if it's Sharleen's need for independence is in a way due to her mom's wanting her to be independent to and sort of like I mean she has to get it from somewhere right? 00:37:55DOROTHY Yes. 00:37:55GONZALO BACIGALUPE Yeah. 00:37:55Amber 00:37:55AMBER Yeah that was a kind of a question I had. Well, what were Patti's dreams for her children in making this enormous transition from Iran, right. 00:38:05GONZALO BACIGALUPE Yeah. 00:38:05AMBER To the States, this huge transition, I mean, there must have been a dream, some purpose that was bringing her over here, and I was really curious what her thoughts back, I guess, 20 years ago or something like that. And I loved Sharleen's metaphor of the birds, the wings feeling, really weighing her down right now. 00:38:30GONZALO BACIGALUPE And at the same the time, the wings are supposed to be as somewhat you fly on. Yeah. 00:38:35AMBER Yeah. And so at that kind tied into my thoughts about what were Patti's dreams for her -- duckling in a way. I do not just kind of rambling thoughts about duckling is calling around and the infant their mom and their mind they follow her around forever even when they grow up, but they do eventually gained some distance more than they had. 00:39:00GONZALO BACIGALUPE Maybe one comment, so maybe you want to say something else, I mean, maybe there is a couple of burning comments that people want to -- 00:39:05ISAAC I know the family really loves each other. Even if they argue, you see that there is a sense of care and compassion there for each other and I don't think that. 00:39:20GONZALO BACIGALUPE And in that sense, it must be very frustrating to get into this stuff, it's like. 00:39:25ISAAC Oh yeah, absolutely.
  • 62. 00:39:25AMBER Yeah Patti made that comment. Even when we are fighting, I know we love each other. 00:39:30ISAAC I said they're going, you know, that's exactly right, when she said that and even though, Sharleen is -- it seems like it's little bit tough love going on, on behalf -- from Sharleen's part of she representing all the kids, from kids towards their mom, and saying, mom, they love you, but we want you to be able to function on your own and I don't know how that kind of fits in with everybody. 00:40:00GONZALO BACIGALUPE Yeah. I was wondering what it is for a kid even if it's an adult, I mean and clearly these are -- kids were becoming adults I mean, Sharleen put it very well. But it must be really hard to see your mom becoming a little bit, you know sometimes like a kid to, I mean, that they need to take care of so soon. 00:40:25ISAAC Yeah. 00:40:25ROBERTA And she made that comment if she was older it would be different, but she is younger. And I don't think they expected, I imagine she is torn with wanting to live her own life and wanting to take care of her mom, I'm sure she is struggling deeply. 00:40:45GONZALO BACIGALUPE Any of you thinking as a therapist, putting yourself in Sandi's shoes and anything that you may think that Sandi is having to deal with or some dilemma that she may be struggling with? 00:41:00ROBERTA What I felt for Sandi, because I think this must be very difficult for her also to, because the families seems even though they have said they have grown and they have made changes that they are almost stuck on that and I imagine Sandi is probably having a hard time getting over that stuckness, and so that's what I see Sandi probably struggling with. It's just being stuck and where do I go from here, where do I take the family from here? 00:41:30GONZALO BACIGALUPE I was wondering, I mean, and the reason I guess I had a self-interest in asking because I was wondering and wanted to check with you guys, I mean,
  • 63. since she's also from Iran I mean, people might think that she is more of an expert on this family. And of course, there are things that have to do with being from Iran. Also, the things that probably have to do with being an immigrant, but also there is some tragic things that have happened in this family and that you know, so I wonder how she at sometimes might feel like not necessary knowing what to do and while at the same time, feeling very well connected with this family. 00:42:05AMBER Oh I think she is. 00:42:10ROBERTA She shows she's well connected with that. 00:42:10DOROTHY Oh yeah. And it must be very frustrating because how do you improve the quality of life for Patti, especially for the family in general, I mean, it must be very frustrating. I mean, what concrete steps do to take. 00:42:30GONZALO BACIGALUPE Okay. Alright. Thank you. 00:42:35Family & Sandi Return 00:42:35GONZALO BACIGALUPE I generally ask after this, we call this is a reflecting team, if you had any reactions, any thoughts or -- and you don't need to address everything that was -- I mean, anything that strike you? 00:42:50SANDI For me, I really felt that they hit -- they touched the right sensitive part as far as being stuck, I'm always thinking okay, what else, what can I do to really -- what can I, I come with ideas of goal setting, achieving goals, and trying to figure out what else can I do, so the family can -- 00:43:25GONZALO BACIGALUPE Move forward. 00:43:25SANDI Move forward. 00:43:25GONZALO BACIGALUPE Patti, did you, of what, all what you heard, there was something that struck you something new or interesting or --? 00:43:35PATTI Nothing, they just talk about discipline on this - - think you were asking me about Shireen, how do I feel and I told you I have been grieved and it's over, but I was thinking about, it's always in my head. I don't think I never going to forget it. It's always in my head and sometimes I feel like, maybe if I was there, it wouldn't happen and then I think
  • 64. about rest of them, what could have happened to the rest of them, maybe if I'd take them all, what would be happened to all of them. So, I don't know. 00:44:20GONZALO BACIGALUPE Do you move back and forth between that. Sharleen how about you, anything that strike you as? 00:44:25SHARLEEN Oh pretty much everything everybody said was really interesting to hear about. 00:44:30GONZALO BACIGALUPE Anything in particular that? 00:44:35SHARLEEN I don't think so. 00:44:35GONZALO BACIGALUPE You don't think so. Is there a movement and this is something that it's like you have been working for a year and a half, you have been going through some very difficult stuff. Do you see yourselves and maybe you can imagine your siblings thinking about this. Having other, so like very difficult conversations therapy, I mean do you see yourselves having to deal with tough issues? Or will you say that this is the worst so to speak? 00:45:25PATTI This is the worst. Just argue with them because I love them and I don't want to argue with them. I want them to have a good life and get married and move on with their life and I see them happy in their life. 00:45:40SHARLEEN And sometimes she wants to choose our happiness for us, and that's not going to work out here. 00:45:45GONZALO BACIGALUPE Tell me how that works, I mean, you guys are -- 00:45:45SHARLEEN She wants to like choose our friends or choose where I hang out or boyfriends or husbands. 00:45:55GONZALO BACIGALUPE And she probably gave up already. 00:45:55SHARLEEN No, no. That's the thing. 00:46:00GONZALO BACIGALUPE You really think that's not the -- 00:46:00SHARLEEN No, that's the thing, she hasn't given up. 00:46:00PATTI I was supposed to.
  • 65. 00:46:05GONZALO BACIGALUPE She hasn't given up? 00:46:05SHARLEEN No. 00:46:05PATTI I was 14 when my parents chose my husband for me and I got married. And he was a nightmare, he was a man from hell, I think, sometimes. But I hate to say that especially in front of the boys, but he was. But the thing is sometimes I think is not fair what happened to me, I do it to them, but sometimes, I feel like if I don't get involved they don't know what to do. 00:46:30SHARLEEN She doesn't leave things alone like if the water is all calm, she has to drop a rock. She doesn't let things be. 00:46:35PATTI I see there are good looking guys, I keep telling them, look at him, he is cute, look at him, get close to him or something like that, I want them to get married. 00:46:50GONZALO BACIGALUPE But in a way you gave up the notion that you're going to have to choose. 00:46:50PATTI Not they choose, yes. 00:46:55GONZALO BACIGALUPE A boy I mean, for them? 00:46:55PATTI Choose, yes, I don't want to choose her husband. 00:46:55SHARLEEN Sometimes I feel like she suffocates us with her opinions and her thoughts and her beliefs. 00:47:05GONZALO BACIGALUPE Tell me about an opinion lately. 00:47:05SHARLEEN I mean, they are nice, but. 00:47:10GONZALO BACIGALUPE Some of the opinion that really -- 00:47:10SHARLEEN They make sense, but they make sense to you, not everybody has to go along with what you thing is the best way to do things. And she feels like, if you want to be a winner, you have to do it her way. 00:47:20GONZALO BACIGALUPE Who is the more opinionated at home? I mean, she has a strong opinion, but who else? 00:47:30SHARLEEN I think we all are that's why we don't get
  • 66. along. Everybody has an input. 00:47:30GONZALO BACIGALUPE And do you have a strong opinion of how your mom should behave, do you see --? 00:47:40SHARLEEN Yeah, I just wish she should be more calm, and what just she acts, so. 00:47:40GONZALO BACIGALUPE Is there any space in this, which I mean, you did say that before that you have the dream that things were, that you were more calm, so that you could relate with her in a different level. Is there some space for her not be so calm? 00:47:55SHARLEEN I mean, her house is what she creates for herself, to be calm or not be calm right. 00:48:00PATTI Sharleen, and most of the time you guys come over there even with my bad fit dinner is ready, lunch is is ready. 00:48:10SHARLEEN Yeah. 00:48:10PATTI We sit, talk and have fun, but sometimes like well, yesterday when I asked you to spend time with me you said, not it was an argument. 00:48:15SHARLEEN I can't, I had plans. 00:48:20PATTI And most of the time they come over there and they have fun. 00:48:20GONZALO BACIGALUPE But aren't you -- 00:48:20PATTI It's not always fun. 00:48:25SHARLEEN Of course. 00:48:25GONZALO BACIGALUPE Are you willing to allow for your kids to sometimes not to respond to your demand of what you want, I mean, is there sometimes some voice in you says, you know, maybe I know I will like that, but it doesn't make sense again. 00:48:40PATTI I do. You should have seen me before. 00:48:45GONZALO BACIGALUPE Tell me about that. 00:48:45PATTI No, honest, I used to want them to be there all of the time, but not now. 00:48:50GONZALO BACIGALUPE I like your sense of humor actually.
  • 67. 00:48:50PATTI Thank you. No, honest I used to be to be want them to be there all of the time. 00:48:55GONZALO BACIGALUPE Ah, ha. So, now you want them sometimes, not all the time. 00:49:00PATTI Like when they moved out, the first one moved out, I want her to call every. 00:49:05GONZALO BACIGALUPE You were crazy. 00:49:05PATTI Every hour, every hour, tell me what is going on, where is she going, what's she doing and everything. Now, I changed a lot. Thanks to Sandi, I give them lots of freedom and space and I let them to choose what they should do and give them lots of freedom, don't I? 00:49:20GONZALO BACIGALUPE Have you been looking for boys for her. 00:49:25SHARLEEN Nobody remind her too. 00:49:30GONZALO BACIGALUPE Won't you remind her to look for boys for you. 00:49:30SHARLEEN Yeah, too much. 00:49:30GONZALO BACIGALUPE So sometimes, I mean, in a way you're seeing the changes, but sometimes you get as obnoxious about it. 00:49:40SHARLEEN No, sometimes I just give up on her because I feel like, I don't know how to get through her. 00:49:45GONZALO BACIGALUPE Patti, let me switch a little a bit, because she said something that you probably guys can sort of like talk and addressing therapy. If you were not having this pain and you were not having this serious difficulty to walk, which is in a way sort of like a new member in the family, I mean, is a new situation I guess for you, it was not there. How -- what would you be doing? 00:50:10PATTI I was working first of all. 00:50:10GONZALO BACIGALUPE What were you doing? 00:50:10PATTI I was caregiver and I have told you. And -- 00:50:15GONZALO BACIGALUPE Oh I'm sorry. 00:50:15PATTI I was a caregiver and I would be working 8, 12 hours a day and sometimes when I was off during the weekend I
  • 68. was shopping at the mall. When I go to a store I see, for example, meat are on sale I buy them all meats whatever it's out there like, call her, I bought you meat, it's awesome, it was all sometime I get it. Do things for them all. 00:50:35SHARLEEN And that's not right, because she is not letting us grow up and have responsibility, she wants to do things, these things for us and she -- 00:50:45PATTI Who said it is not right? 00:50:45SHARLEEN She doesn't understand. 00:50:45PATTI Even if I don't call and still you come and take it from the freezer. 00:50:45SHARLEEN Mom, the thing I'm trying to -- she cooks everyday as she delivers it to my sister's food -- house everyday. I tell her let her learn on her own, you do things for yourself, go for -- don't meat stuff, go for a massage, go for this and that, clean your room if you are bored. Learn how to read and write if you are bored, do something else, stop involving your plans so much around your children, find other hobbies, find other things to entertain your life with. 00:51:15GONZALO BACIGALUPE What other things that she does for you or your siblings you will like her to continue doing? 00:51:25SHARLEEN Be the same mother that she has always been, but just not expect so much because she gives, and then, she expects so much back in return, her expectations are too high. 00:51:35GONZALO BACIGALUPE So you will like her to continue cooking and doing the things? 00:51:35SHARLEEN Once in a while. Once in -- don't make it like, it's a family ritual every week. Let it -- let us -- treat us like we have grown up and are out and doing our own life because that's how it actually is. It's just too much sometimes. I feel like, if it wasn't because of my involvement with -- so much of my energy involved with her, I would have probably take off to Europe for six months, work out there, do something, I would have a free mind to decide for myself, what to do for
  • 69. like a summer time. 00:52:10GONZALO BACIGALUPE Do you have a sense that your mom may think that if she doesn't do those things, that she would be thinking that she is sort of like neglecting with you guys? 00:52:20SHARLEEN Yeah, she would feel like she has left us alone, that's just her habit or how she grew up, her mom probably that these things. 00:52:25GONZALO BACIGALUPE The time I will report her to child protector servants and doing the stuff. 00:52:30SHARLEEN I don't know about it, but she feels like she's being the best mom. 00:52:35GONZALO BACIGALUPE Are you ever thought about reporting her for, I mean for -- 00:52:35SANDI For great mom. 00:52:40GONZALO BACIGALUPE For actually, no, for letting them be their -- do their things. 00:52:45SANDI On their own. 00:52:45GONZALO BACIGALUPE Yeah. And have you thought about you could be reported, if you let them to be more independent or--? 00:52:50PATTI No, not. 00:52:50GONZALO BACIGALUPE I mean I never thought that in a way, I mean, negligence can be different. 00:52:55PATTI I'd tell they love that. 00:52:55GONZALO BACIGALUPE I was wondering if what it seems to bother you is not so much what she may do or what she may expect after she does it? 00:53:05SHARLEEN I feel like I give her an inch and then she expects a mile. I give her like, I try to please her and please her let's say, three days in a row, and she gets overexcited, then she thinks like it's a shopping for everyday. 00:53:15GONZALO BACIGALUPE What are you thinking Patti when you hear that? I mean, you are not getting angry at this point, you were so like maybe she has a point. 00:53:25PATTI No, I will call her and I leave her home, but
  • 70. no. 00:53:25SHARLEEN It's really that's how she things then, then I try to -- 00:53:25PATTI I swear to god, I will not call her. 00:53:25SHARLEEN See, that's -- 00:53:30PATTI I will not contact her and just leave her alone from now. 00:53:30SHARLEEN She's. I try to explain a point to her. 00:53:35PATTI No that's not the point., 00:53:35SHARLEEN Then she feels this way, I'm here to like, you know I feel. 00:53:35PATTI I will give you the space as much as you want. 00:53:40SHARLEEN That's how she feels and I feel like sometimes she's like so in her zoom box that she's not willing to like let them down. 00:53:45PATTI As a mother, how old your kids get then you see them like they are catching the fire, you want to grab them and not let them burn theirself. 00:53:55GONZALO BACIGALUPE Your kids are going to be your kids. 00:53:55SHARLEEN Yeah, but you can't interfere. 00:53:55PATTI It doesn't matter how old they get, I want to go take them, especially because I had that abuser husband, I don't want she marry somebody abuser. 00:54:05GONZALO BACIGALUPE Let me -- we are going to have to stop very soon and I was wondering Sandi, do you sometimes, in the sessions struggle with helping them to feed out how to negotiate these things. 00:54:15SANDI I do constantly. 00:54:20GONZALO BACIGALUPE And do you have a sense that that is sort of like that the struggle is that you know the man for mom to be more balanced, less the man they know or whatever, or controlling or intuitive or whatever the way the kids may see it, or the way Patti see it as, you know, this is the way I understand being a mother and this is the way I do things and this is when I want to take care of them. How each put the
  • 71. other one in sort of like a paradox, it's like, love me, don't love me kind of thing, you know. 00:55:00SANDI Right, exactly. 00:55:00GONZALO BACIGALUPE It's care for me, but don't care for me. It's how to find that. 00:55:05SANDI Right. 00:55:05GONZALO BACIGALUPE That balance I guess. 00:55:05SANDI Exactly. I have been focusing on more negotiation between them, and how they can compromise as far as what makes Patti happy and what makes the children happy. As for one big issue with Patti is the way they cloth also, the way they choose their clothing, that is another big issue. She is not happy with some of this stuff that you be talked about this before. So constantly I'm trying to balance between our way of living back home and our way of living over here, and by negotiation and compromise. 00:56:00PATTI It's mostly Shireen, the way she cloth, I don't like it at all, I cannot even stand to look at her. I will have to steal it and throw it into trash can. 00:56:10GONZALO BACIGALUPE Although, you know here you -- it's interesting because in a way here, you know in the stage you might seem like very conservative around it, but if you were to be Iran with all of the kids, you'll be considered sort of like the revolutionary and almost hang you for allowing your kids to wear the clothing they are wearing right? 00:56:25SANDI Exactly. 00:56:25GONZALO BACIGALUPE And that's that although, I don't know how -- although you are here, you saw you feel like you are there in some way, I mean, you carry your culture around is about you. 00:56:40PATTI What do you suggest for me? 00:56:45GONZALO BACIGALUPE What do I suggest for you? I don't know. 00:56:45PATTI Leave them alone. 00:56:50GONZALO BACIGALUPE You cannot leave them alone. Right. But let me -- I don't think that you can leave them
  • 72. alone. 00:56:55PATTI I'll try it. 00:56:55GONZALO BACIGALUPE But at the same time, I think that you need to add another something that you need to do, I mean, I don't think that you can leave them. 00:57:05SHARLEEN Yeah, find something to do. 00:57:05GONZALO BACIGALUPE I don't know. 00:57:05SHARLEEN For real, find something to do. 00:57:10GONZALO BACIGALUPE I don't think that you can leave them alone. I think that you're still going to be concerned about them. I mean it's impossible for you, what impress me and this is something that coming to terms with what is happening to you and your body, it's not an easy task, I mean, definitely it's -- it must be really, really, really hard, and how to have other people who can be a resource. I mean, you were having that conversation right now, how you can have other people who can be resourced to help you with that, I mean, that's something that I think that should really be having conversation, the two of you. 00:57:45SANDI Yeah. 00:57:45GONZALO BACIGALUPE About what kinds of resources you can use besides you know, getting some help from your kids. I mean, because there are some things that your kids not able to do to help you with dealing with this pain and you know you were talking about your weight and how to heal this and on and on. I mean, this is sort of like a new adjustment. And before you were dealing something to happen in the past that came to visit during the present, you were happy a year and a half, you have always that sort of suddenly you were faced with this very traumatic event, series of events I, mean, what happened to you before you came here from what I understand was very traumatic. And sort of like now you are face something that is very traumatic. I mean, how do you deal with this excruciating pain, difficulty, I mean, how can you be able to walk in your own and having to -- I mean, that's -- I find it very dramatic. It's sort of like given up something, and
  • 73. you cannot just run away to another culture to run away from this pain. I mean, and clearly, you're going to have to join something to be able to be aware, I mean, join, I don't know exactly what, because that's something that you probably know more about. 00:59:00SANDI We've been exploring different options as far as resources. Patti came up and you came up with weight watchers idea. And she said, that's some place I can join and it makes me feel good and I said, okay, then you are benefiting so many ways, your health, your weight and also the psychologically you are benefiting from that. 00:59:25GONZALO BACIGALUPE Hope this was somehow helpful. And we don't have more time. I'm really privileged for having you coming to the interview with someone you do not know anything about. I'm going to still thinking about this as I watch the video tape and I watch where we and I also would feel that there are things that maybe I didn't ask, but that you would have asked and I would just share them with you. Alright, because I think that you guys said so much and shared so much with us. Alright. So, thank you. 00:59:55SANDI Thank you. 00:59:55GONZALO BACIGALUPE Thank you. 01:00:00SANDI Thank you. 01:00:00Family & Sandi Return 01:00:00Epilogue 01:00:00& 01:00:00Afterthoughts 01:00:00GONZALO BACIGALUPE I'm going to comment on some themes that had to with the interview per se with the family, the reflecting team for some conceptual ideas that I think that maybe important for people to know, and also to reflect on my own thinking as I was doing the interview and also about some of the things that I may have missed after having done the interview and having seen watch the video tape a couple of times. One of the things that I did not is in the case, in the Sandi's case is how difficult it is for the reflecting