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7 Managing Marketing Activities
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Marketing is too important to be left to the marketing
department.
—David Packard
Learning Objectives
After reading this chapter, you should be able to do the
following:
• Define marketing and explain how the marketing concept
is patient centered in HCOs.
• Discuss the relationship between organizational planning
and marketing planning with regard to objectives
and strategies throughout the planning levels.
• Name the three basic marketing strategies that can be used
under the product/market approach to market-
ing strategy development, identify two other approaches to
marketing strategy development, and list four
factors influencing the strategy selection.
• Discuss how the four strategic elements of the marketing
mix become marketing tactics for implementing
the selected marketing strategy.
• Identify two basic types of organizational structures for
managing marketing activities.

• Explain how ethical issues in marketing relate to
marketing decisions, and provide examples of ethical
issues facing healthcare providers.
Section 7.1What Is Marketing?
Introduction
This chapter provides an overview of marketing, the
relationship between marketing plan-
ning and overall organizational planning, basic marketing
strategies, and approaches to orga-
nizing marketing activities in an HCO. This chapter also
includes a discussion of the ethical
decision-making process in marketing and lays the groundwork
for later chapters on the mar-
keting process and its role in HCOs.
7.1 What Is Marketing?
The marketing of HCOs is a relatively recent phenomenon. It
was as late as 1977 that the
American Hospital Association held its first convocation on
marketing. Much of the early mar-
keting efforts by hospitals were aimed toward the recruitment
and retention of physicians.
Many physicians remained skeptical of marketing to patients
and believed it was unprofes-
sional. However, as healthcare has become more complex and
expensive, HCOs and individual
healthcare providers have seen the need to better communicate
to patients the value of their
services (MacStravic, 1994).
Over the last two decades, the discussion of marketing in HCOs

has evolved from whether
it was even appropriate for HCOs to use marketing to give the
organization a competitive
advantage and “tell its story.” But what is meant by the term
marketing?
Various definitions of marketing have evolved over the years,
but one that appears to be fairly
complete is as follows: Marketing directs those activities that
involve the creation and distribu-
tion of products and services to identified market segments.
Several key words in this defini-
tion need further explanation. First, what is meant by the words
marketing directs. This is a
managerial perspective rather than a residual perspective, which
is concerned only with
what has to be done to get goods and services to customers. A
managerial perspective is one
that is proactive, customer oriented, and aligned with the firm’s
overall strategy. In contrast, a
residual perspective is one that is reactive and only deals with
needs as they arise. Thus, mar-
keting is not just a group of activities but, more specifically,
activities that are controlled in
their execution to attain identifiable objectives. Second,
marketing involves the performance
of specific activities or functions. These functions constitute the
work or substance of what
marketing is all about. To be involved in marketing means to be
involved in the planning,
execution, and control of these activities.
Third, marketing involves both the creation and distribution of
goods and services.
Although the service is actually created by the operating
function, marketing personnel are

very much concerned not only about the way goods are created
and services are performed
but also the way customers utilize goods and services.
Marketing needs to have a vital role in
the creation as well as the distribution of goods and services. In
fact, a well-conceived service
or good makes the rest of the marketing tasks easier to perform.
Finally, marketing’s concern with customers, and meeting a
need in the marketplace, is
patient centered in an HCO. However, marketing is particularly
concerned with customers
preselected by management as the market segment(s) on which
the organization will con-
centrate. Thus, specific customers with their specific needs
become the focal point of market-
ing activities.
Section 7.2The Marketing Concept
7.2 The Marketing Concept
The marketing concept is a business orientation that focuses on
satisfying customers’ needs
at acceptable levels of revenue and costs. In for-profit
organizations, acceptable levels of rev-
enue and costs are defined in terms of a target return on
investment, while in not-for-profit
organizations the focus is achieving a balance between revenues
and costs.
Organizations that have a true marketing orientation focus on
addressing the needs and
wants of one or more targeted segments of the market. However,
managers with marketing

titles may apply other business philosophies that, in reality, do
not reflect authentic market-
ing thought. Table 7.1 shows three different business
orientations that have been used as
the operating philosophies behind management decision-making
(Stevens, Loudon, Wrenn,
& Mansfield, 2006). The term dominant in the table identifies
the core objective, which gives
the orientation its name. Present means that the orientation
includes that objective, but does
not use it as the centrally controlling goal in orienting the
manager’s thoughts about his or
her company, its services, or its customers. Not pertinent means
that objective has no rel-
evance, pertinence, or connection with the orientation
described. This table makes it clear
that the service and selling orientations are internally driven.
Put simply, managers using
these orientations determine what they want to dictate to the
market. The last orientation—
marketing—contains the elements of an outside-in, market-
driven, or customer-oriented
philosophy, which stresses discovery of market opportunities,
marketplace input regarding
the organization’s claim of a competitive advantage, and the
integration of effort across all
aspects of the organization to deliver quality and customer
satisfaction.
Table 7.1: Possible organizational orientations
Service
orientation
Selling
orientation

Marketing
orientation
Desire to capitalize on syner-
gies and efficiencies in operating
processes
Dominant Present Present
Attention to designing acceptable
levels of quality services
Not Pertinent Present Present
Dedicated resources to stimulating
interest and desire for increasing
revenues
Not Pertinent Dominant Present
Focus on identifying and satisfying
needs and wants of customers
Not Pertinent Not Pertinent Dominant
Considering the short- and long-
term effects of actions on custom-
ers and on society
Not Pertinent Not Pertinent Dominant
HCOs have been concerned with the delivery of a satisfactory
level of patient services for
decades. Most services, including healthcare services, are
intangible. That is, they cannot be

touched or held before being purchased. Additionally, the
delivery of a service is dependent
on the ability of the service provider. As service providers are
human, the quality of service
varies from patient to patient.
Section 7.2The Marketing Concept
Traditional strategies in healthcare for overcoming these
limitations include improving the
appearance of physical facilities, projecting competence, and
employing empathetic per-
sonnel (Stevens et al., 2006). However, these strategies have
been shown to be inadequate,
as healthcare has become more expensive and complex, from
both the providers’ and the
patients’ perspectives (Merlino & Raman, 2013).
According to Michael Porter and Thomas Lee, “the overarching
goals for providers . . . must
be improving value for patients, where value is defined as the
health outcomes achieved that
matter to patients relative to the cost of achieving those
outcomes” (Porter & Lee, 2013, p.
52). The implied message for HCOs is not just to put together
procedures to help patients
navigate the system, but to fundamentally change the system.
The marketing orientation is particularly well suited to dealing
with the internal and exter-
nal environmental forces currently facing healthcare managers.
Marketing includes all of the
positive contributions of the service and selling philosophies,
but it adds concern for the long-

term effects of the organization’s actions and services on its
customers, as well as the desire
to consider the effects of the organization’s actions on society
at large. Putting the marketing-
orientation philosophy into practice requires a planning
procedure that transforms the exter-
nal consumer orientation into marketing activities.
Thus, the marketing orientation holds that the only social and
economic justification for the
existence of a business enterprise is this: the satisfaction of
customer needs, either at a profit
or at acceptable levels of revenues and costs, and with due
diligence for the long-run wel-
fare of the customer and society. A firm’s existence is justified
socially in meeting customer
needs—directly through the provision of goods and services,
and indirectly through being
a good citizen of its operating environment. In healthcare,
meeting customer needs means
being a patient-centered organization. Thus, everyone in an
HCO is concerned with patient
care, including nonmedical employees. In the U.S. economy, the
marketing-orientation philos-
ophy is exactly why organizations were given the right by
society to own and use resources to
produce goods and services. A firm finds economic justification
by making a profit or generat-
ing enough revenue to cover costs. Profit or breakeven for
nonprofit organizations rewards
the stakeholders’ investment in the organization and supports
the continued availability of
funds. Customer needs become the focus of firms that operate
under the marketing-orienta-
tion philosophy.

Traditionally, medical providers have seen their role as healers
who provide a valuable social
service. Costs have been secondary. The need for economic
justification has created tension
for many healthcare providers. However, providers cannot just
continue to increase fee-for-
service. Many physicians lose money on Medicare and Medicaid
patients but have been able
to make up the difference from the uninsured and commercial
insurance patients. With more
patients now covered by governmental programs and with
commercial insurers’ and employ-
ers’ emphasis on costs, those days are over (Porter & Lee,
2013).
Section 7.3The Organizational Planning and Marketing Planning
Connection
Administrators and other healthcare providers who have adopted
the marketing-orientation
philosophy must continually survey the environment to detect
changes in consumer needs,
or other related variables, that warrant the altering of their
marketing activities. Revenues,
in effect, become votes to help management judge the
effectiveness of its efforts in meeting
market needs compared to those of competitors; and profits or
breakeven serve to judge the
efficiency of management in this attempt. Putting the
marketing-orientation philosophy into
practice requires effective management of the marketing
process.
7.3 The Organizational Planning and

Marketing Planning Connection
The strategic planning process described in the first six chapters
of this textbook has con-
centrated on the organization’s overall strategic plan. The
development of that overarch-
ing strategic plan precedes the development of the strategic
marketing plan, as well as
the annual or operating marketing plan. The strategic marketing
plan contains the over-
all approaches to marketing within an HCO, and the annual or
operating marketing plan
spells out the details of what is to be done on a day-to-day,
week-to-week, and month-to-
month basis to translate the major strategies into specific
actions, responsibilities, and time
schedules.
Both the strategic marketing and the annual operational
marketing plans must be consistent
with the organization’s overall strategic plan. Although
marketing plans are more detailed and
cover only the marketing functions, the marketing planning
process involves steps similar to
the strategic planning process at the organization level. These
steps usually involve including
a detailed analysis of the company’s situation, setting specific
objectives, developing strategy,
implementing strategy, and evaluating and controlling strategy.
The details of the marketing
planning process are discussed in Chapter 8.
The relationship between the organization’s strategic plan,
strategic marketing plan, and
annual operational marketing plan is shown in Figure 7.1
(Loudon, Stevens, & Wrenn, 2005).

Note the connection of both objectives and strategies from the
organization’s strategic plan
to the organization’s strategic marketing plan and, finally, its
annual or operating marketing
plan. This approach to planning ensures that consistency is
maintained between what is done
on a weekly or monthly basis and the organization’s overall
marketing strategy. The stra-
tegic marketing plan is devised from and in turn supports the
organization’s strategic plan.
Connection
Figure 7.1: Organizational and marketing plan relationships
Connecting an organization’s objectives and strategies ensures
that the entire plan maintains
consistency between current actions and the overall marketing
strategy.
f07.01_MHA 626.ai
Operating marketing plan strategy
Operating marketing plan objective—year 1
Overall Marketing strategies
Marketing objective—5 year
Organization strategy
Organization objective

Increase networking effort to increase referrals.
Launch promotional campaign, showing expertise of
staff and remodeled facilities.
Achieve a 2% reduction in operating costs.
Focus on increasing volume of existing services to
reduce costs per unit and achieve economies of scale.
Increase usage rate among existing patients by 10%
over the next 5 years.
Increase usage rate among existing patients by 5%
by the end of the year.
Use market penetration strategies to achieve increased
volume in years 1 and 2, and focus on market
development in years 3–5.
Operating
marketing plan
Strategic
marketing plan
Organization-
level plan
Source: Loudon, D., Stevens, R., & Wrenn, B. (2005).
Marketing management: Text and cases. The Haworth Press,
Inc., p. 126.
Figure 7.2 provides an industry-specific example of how
objectives and strategy should be
consistent throughout the planning levels (Stevens et al., 2006).

Pharmaceutical firm Eli Lilly
and Company chose the service leadership value discipline to
provide strategic direction at
the organization level. Servant leaders are those who want to
lead because they want to serve
first. The servant leader ensures that other people’s highest
priority needs are being served
(Greenleaf, 2002). The organization-level objective is general in
nature and consistent with
Connection
the value discipline. At the strategic marketing level, this
organization’s strategic direction is
focused in one instance on objectives and strategies for its
nonnarcotic analgesic line. The
leading product in the line, Darvon, will be going off-patent
during the year. The objective of
maintaining a high market share in this market would be
impossible, given the influx of new
generic competitors for Darvon, unless new patent-protected
products can be introduced and
physician prescribing habits changed so that an increasing
number of prescriptions will be
written for the new drug. This new product-entry strategy is an
embodiment of the service
leadership organization value discipline.
Figure 7.2: Eli Lilly Pharmaceutical Company
In this industry-specific example, the objectives and the
strategies are consistent throughout the
different levels.

f07.02_MHA 626.ai
Organization Level
Objective: Maintain product leadership in each market.
Strategy: Adopt a product leadership value approach.
Strategic Marketing Level
Objective: Maintain a market share of the nonnarcotic analgesic
market of 80 percent
over the next five years.
Strategy: Introduce new products to take place of products when
they lose patent
protection.
Operating Level
Objective: Call on physicians to detail our more advanced
analgesic with more
efficacy and fewer side effects; call on pharmacists to leave
order blanks at sale prices.
Strategy: Product line extension and aggressive pricing.
Source: Stevens, R., Loudon, D., Wrenn, B., & Mansfield, P.
(2006). The marketing planning guide. The Haworth Press, Inc.,
p. 248.
At the operating level, one of several objectives deals with
tactical implementation of the
product line extension and aggressive pricing strategy. The
objective here is to get the word to

the physicians that a new and improved product, Darvocet, is
now available with advantages
over Darvon, so they should change their prescribing to write
for the new drug. Simultane-
ously, tactics include making detail calls to pharmacists to let
them know that Darvon is now
discounted 30%. If successful, this sale should cause the
pharmacists to stock up on Darvon,
so that prescriptions written for it will be filled with the Lilly
product and not some generic
equivalent. While the pharmacists reduce their Darvon
inventory, the objective effects a
change: physicians prescribing to Darvocet. Hence, there is a
consistency between objectives
and strategies among the three levels, and within any particular
level. It should also be noted
that these objectives and strategies are only a sample of what
would be set for sales volume,
Section 7.4Marketing Strategy
growth, share, percentage of prescriptions written for new
versus old products, and so forth.
Finally, it is important that objectives set in functional areas
other than marketing (finance,
R&D, and so forth) support the overall organization strategy to
pursue service leadership.
7.4 Marketing Strategy
Like management itself, marketing strategy development is both
a science and an art, a prod-
uct of both logic and creativity. The scientific aspect deals with
assembling and allocating the
resources necessary to achieve a company’s marketing

objectives by emphasizing opportuni-
ties, costs, and time. The art of strategy is mainly concerned
with the use of resources, includ-
ing motivation of the workforce, sensitivity to the environment,
and ability to readjust to the
counterstrategies of competitors.
Marketing strategies provide direction for marketing efforts.
Alternate strategies are courses
of action managers evaluate before committing to the specific
course of action outlined in the
marketing plan. Thus, strategy links objectives and results.
Strategy is the answer to one of
the basic questions posed in a marketing plan: How are we
going to get there?
The development of a marketing strategy usually encompasses a
two-step process: (a) identi-
fication of the target market (discussed in detail in Chapter 8);
and (b) creation of a market-
ing mix aimed at satisfying the needs of that target market
(discussed in detail in Chapters
9–11). The marketing strategy used by a company is the result
of the blending together of
various marketing elements. These elements, which are known
as the four Ps of marketing,
consist of (a) the product/service to be offered to buyers; (b) the
distribution of products
to various outlets, referred to as place; (c) the promotion or
communications to prospective
customers, using various promotional techniques; and (d) the
price charged for the product
or service. The term marketing mix describes these various
elements. Therefore, marketing
strategy development may be viewed as developing a marketing
mix aimed at satisfying the

needs of selected market segments and accomplishing specific
marketing objectives.
As Figure 7.3 shows, marketing-mix decisions are made with a
particular market segment in
mind. Marketing effort is targeted at the selected segments
through blending the elements
of the marketing mix into a cohesive strategy aimed at
satisfying those specific segments. An
organization targeting several segments must develop an overall
marketing program, which
includes all of its marketing activities.
The development of alternate marketing strategies can be
viewed in many ways, but three
approaches will be discussed in this chapter. First, there is the
overall way a firm approaches
the markets it is attempting to serve. Second, there is one firm’s
strategy in relation to com-
petitive strategies. The third approach deals with the position of
a product or firm in relation
to competitive offerings.
Figure 7.3: The marketing mix and target markets
Marketing activities, usually a blend of different elements,
target the specific market identified by the
organization.
f07.03_MHA 626.ai
Selected

Target
Markets
Product/Service:
Features
Quality
Branding
Place:
Location
Satellite facilities
Physical attributes
Promotion:
Advertising
Sales promotion
Publicity
Social media
Price:
Fee structure
Payment options
Payment terms
Product/Market-Oriented Strategies
The product/market approach to strategy development is
illustrated in Table 7.2. Three
approaches can be used under this strategy development
concept. Undifferentiated strat-
egy basically offers one product aimed at all market segments.
Even if differences in market
segments are recognized, these differences are not incorporated
into the firm’s marketing
activities. Ford Motor Company used such a strategy in its early
days when its only model

was the Model T. As Henry Ford might have said, “You can
have any color you want, as long as
it’s black.”
An undifferentiated strategy only works when there is little or
no competition. New com-
petitors that enter the market, using a differentiated strategy or
a concentrated strategy, soon
begin to erode the market share of an undifferentiated strategist.
For example, a hospital with
an undifferentiated strategy advertises its image, rather than
specific services. The goal is to
convince patients to use the hospital when they need care, even
if it is just a one-time sale.
As hospitals have become savvier in their marketing efforts,
they have begun to develop dif-
ferent service features, such as heart health, newborn care, and
behavioral health. These new
marketing approaches are effective against the one-size-fits-all
message that many hospitals
initially adopted.
Table 7.2a: Undifferentiated hospital marketing
Image Image Image
Image Image Image
Image Image Image
Table 7.2b: Segmentation, or differentiated, hospital marketing

Newborn care Cancer treatment Heart health
Sports medicine Digestive health Radiology
Neuroscience Rehabilitation Women’s health
Table 7.2c: Concentrated, or focused, hospital marketing
Behavioral health
A firm using a segmentation marketing strategy recognizes
differences in the needs of each
market segment and responds by developing a unique marketing
mix for each segment pur-
sued. Of course, not all segments have to be pursued, but at
least two are required to use the
term segmentation strategy. When a company develops mixes
aimed at different segments,
it can also be referred to as a market segmentation strategy. A
firm using this approach usu-
ally offers a wide variety of products to meet the needs of
customers in many segments.
Focused marketing strategies pinpoint one segment of the
market and concentrate all their
efforts on that one segment. A financial firm specializing in
mergers and acquisitions would
use this strategy as would firms specializing in financing new
ventures. Firms using this
strategy option develop a distinctive competence for doing one
thing well. Focused market-
ing strategies are based on finding growth segments with unique
requirements the firm can
meet. The vision of Cancer Treatment Centers of America to be
“the premier center for heal-

ing and hope” for cancer patients is an example of a focused
marketing strategy based on
unique end-user needs.
The basic difference between the segmentation marketing
strategy and the focused market-
ing strategy is the number of segments the firm attempts to
serve. Firms following a focused
strategy target their efforts on one segment only. The factors
that influence the choice of a
particular marketing strategy will be discussed in another
section of this chapter.
Baylor Medical Center at McKinney in McKinney, Texas is
following a segmentation marketing
strategy. This full-service hospital offers advanced treatment
for many medical specialties,
including cancer care, digestive diseases, emergency care, heart
and vascular, imaging and
radiology, neuroscience, orthopedics, rehabilitation and
physical therapy, transplant services,
and women’s health (Baylor Health Care System, 2013).
A focused marketing strategy concentrates on one segment of
the market and directs all of its
efforts to that one segment. For example, St. Jude Children’s
Research Hospital in Memphis,
Tennessee treats children with cancer and other catastrophic
diseases and seeks to advance
cures for pediatric catastrophic diseases through research (St.
Jude Children’s Research Hos-

pital, 2013). Brentwood Hospital in Shreveport, Louisiana is a
psychiatric hospital that pro-
vides treatment for chemical dependency and other behavioral
health disorders (Brentwood
Hospital, 2013). A psychologist who accepts only cash-paying
clients is also adopting a focused
marketing strategy. By refusing to take insurance benefits, the
psychologist ensures that no
record is kept by insurance companies to label the client or
patient as mentally unstable.
Competitive Marketing Strategies
Another approach to strategy development employs competitive
marketing strategies cur-
rently used in the market. Table 7.3 classifies the strategies that
may be used by a company
based on its market position. Market position is defined in terms
of one firm’s share of the
total market and its relation to competitors in the industry.
Table 7.3 identifies four market
positions and some possible strategies for each (Kotler, 1980).
Table 7.3: Competitive marketing strategies
Market position Possible strategies
Market leader
Firm acknowledged as the leader, with
the largest market share of the relevant
market.
1. Expand total market: Develop new uses, new users,
or
more usage by existing customers.
2. Protect market share: Use innovative

marketing tactics or
retaliate against challengers.
Market challenger
Second, third, or fourth firm in market
share. May be quite large, though smaller
in a relevant market than the market
leader.
1. Direct attack strategy: Meet leader head-on
with aggres-
sive promotion and/or prices.
2. Backdoor strategy: Go around leader options
through
innovative strategy.
3. Guppy strategy: Increase market share by
going after
smaller firms.
Market follower
A firm that chooses not to challenge
the leader and is content with market
conditions.
1. Copy leader: Match as closely as
possible leader’s strategy
without directly challenging.
2. Coping strategy: Adjust to strategies of both
leader and
challenger without direct confrontation.
Market nicher
A smaller firm that operates in a geo-

graphic or client niche without directly
clashing with competitors. Specialization
is the key to its success.
1. Geographic niche: Specializeby offering quick
response to
customers.
2. Product niche: Offer products that are unique
to the cus-
tomers served.
Market leaders are the recognized leaders that have the largest
market share of the relevant
market. Although their position of dominance may be widely
recognized, their success may
be constantly challenged by other firms. The strategies that are
used by market leaders focus
on expanding their own control of the market while warding off
or countering the activities of
aggressive competitors. The market leader’s strategy becomes
the pivot around which other
competitors adjust their own strategies.
Market challengers are the firms that are constantly trying to
increase their market share
in head-on competition with the leader, attacking the leader at
its weak points or merging
with smaller competitors. Market challengers are usually large
firms in terms of revenues and
profits, and they may be even more profitable than the leader.

The challenger usually tries to
identify weaknesses in the market leader’s strategy and either
confronts or goes around the
leader, or concentrates its efforts on taking over smaller firms.
Pepsi’s challenge of Coke’s
leadership position clearly demonstrates how the challenger’s
strategy can affect the strate-
gies of other competitors. The New Coke, which was closer in
taste to that of Pepsi …
Running Head: ASSESSING CLIENT FAMILY 1
ASSESSING CLIENT FAMILY 6
Assessing Client Family
A comprehensive family assessment entails a practice that
continuously tend to enlighten the process of decision making
via the identification, consideration as well as weighing the
dynamic which impact children and their families. The families
are known to be the security of the children as well as attention
givers. In that case, the comprehensive family assessment is
done in order to know the welfare of children and their families
during circumstances such as their safety issues, dangers of
future treatment, capacity of parent protectiveness and during
the compromise of a child’s well-being. In short, it is used to
gather information that will aid in finding out where a particular
problem comes arises from.
Demographic information: The patient’s lives with his two
parents together with his brother. They are of Hispanic origin
and both his parents were raised by their biological parents. His
brother is six years old and the patient eight.
Presenting problem: A social worker visited their home and was
not satisfied with the living conditions of the patient and his
family. The social worker believes that the environment is not

conducive for child growth
History or present illness: The patient was diagnosed with a
severe case of typhoid which captured the attention of the social
worker. The condition of their home was not at all as required
hence the cases needed intervention.
Past psychiatric history: The patient had no psychiatric history.
None of his family member had the condition as well.
Medical history: The patient has been known to be healthy for a
long time. He never had any serious issues when it comes to his
health.
Substance use history: I assessed the parents of the patient and
found out that the child had not had any experience with drugs,
but the mother admitted taking alcohol when she was pregnant.
But she claims it was neither for long nor repeatedly. However,
the father is a smoker, but he does not smoke inside the house.
Developmental history: There is no evidence of any
developmental problems noted in the Hernandez family. The
parents and kids appeared well nourished. The kids are observed
playing with toys within their developmental stage.
Family psychiatric history: There were no cases of psychiatric
conditions in the family, from their parents to the great
grandparents of the patient.
Psychosocial history: The parents reported that they are
hardworking and providing for their family is their priority;
they appeared to have a healthy spouse relationship. The couple
tends to have a mutual understanding of themselves. The patient
and his brother normally play together and sometimes even with
their neighbor’s children.
History of abuse and/or trauma: The patient as his brother had
no signs of abuse or trauma. However, the father claimed he
was brought up with strict parents that would punish them
harshly. They came to the U.S and they believe that that is not
necessary whatsoever.
Review of systems:

Physical assessment: There is no evidence of physical
abnormality. Their children seemed within the specified stage of
development and there is no signal of mishandling or negligence
noted. Their behavior and appearance are within their average
age; they are well-groomed and healthy. The couple is also well
groomed and well nourished.
Mental status exam: The parents and their children are capable
of speaking English fluently; they know their rights and they
know that they have to care for their children in the best
possible way. They are also aware that if the government
realized negligence then they may lose their children.
Differential diagnosis: The patient who was diagnosed with
typhoid was taken to hospital and is undergoing treatment. The
case was investigated, and it was found out that he had
contacted the disease from the school he was attending. The
parents took good care of the patient and his brother.
Case formulation: The two parents are immigrants in the U.S.,
and they came to find greener pastures. The parents are not in
any way solely responsible for the contraction of the disease by
their child, and because they took him to the hospital, and he is
being treated it means that they are responsible. There parenting
style is also commendable because the patient and his brother
are well behaved, smart, and healthy.
Treatment plan: I recommend that the patient continue with his
medication without fail, and this will be the responsibility if the
parents. They will ensure that the medicines are taken every day
and in time, just as the doctor prescribed. They should also
ensure that they eat healthy and have access to clean drinking
water.
2nd son
1st Son
References
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statistical manual of mental disorders (5th ed.). Washington,
DC: Author.
Paniagua, F. A. (2018). ICD-10 versus DSM-5 on Cultural
Issues. SAGE Journal, 1–14.
https://doi.org/10.1177/2158244018756165
Valdez, J. N. (2012). Psychotherapy with bicultural Hispanic
clients. Psychotherapy Theory Research & Practice, 37(3), 240-
246. https://doi.org/10.1037/h0087712}
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced
practice psychiatric nurse: A how-to guide for evidence-based
practice. New York, NY: Springer.
Running head: HERNANDEZ FAMILY ASSESSMENT
1
HERNANDEZ FAMILY ASSESSMENT
6
Hernandez Family Assessment
The purpose of this paper is to complete a comprehensive
assessment of the Hernandez family by addressing all
information possible from the videos presented in this week’s
module.
Part 1: Comprehensive Client Family Assessment
Demographic information
Juan Hernandez Senior, a 27-year-old Latino man, married to
Elena Hernandez, a 25-year-old Latino woman, and have two
sons, Juan Jr., 8-years-old and Alberto 6-years-old.
Presenting problem
The Administration for Children Services (ACS) referred the
family for allegations of child abuse.
History of present illness
Mr. and Mrs. Hernandez are questioning why they are here.
They are “punishing the children the way we were when we
were their age”. Mr. Hernandez discusses how his father would

make him hold encyclopedias for “hours” when he did not obey
his father. They both express they are good parents, and
everything they do is to better the children’s lives.
Past psychiatric
The style of punishment has been passed down from Mr. and
Mrs. Hernandez parents. Both describe punishment by their
parents as “misery”.
Needs to be added to
Medical history
Substance use history
Development history
There appear to be no developmental delays in any member of
the family at this time
Family psychiatric history
Mr. and Mrs. Hernandez appear to be very concerned about the
reason for the referral. They seem to care genuinely for their
children. In discussing their upbringing, there doesn’t seem to
be a family history of mental illness.
Psychosocial history
Mr. Hernandez appears to be the primary source of income, per
the discussion of overtime and the inconvenience of having to
attend meetings.
History of abuse/trauma
Juan Jr has reported no other form of abuse except for the type
of punishment of holding encyclopedias.
Review of Systems:
Physical assessment
All members of the family appear to be in good health.
Mental status exam
All members of the family are appropriately dressed and well
groomed. The sons are playing together appropriately. Mr. and

Mrs. Hernandez’s speech is clear and appropriate. Mr.
Hernandez is visibly upset about the ACS claims. Mr. and Mrs.
Hernandez appears at this time to be mentally stable with no
abnormal thought processes, insight, or judgment.
Differential diagnosis
V62.4 – Target of (Perceived) adverse discrimination or
persecution (APA, 2013)
The therapist expresses concerns that there may be
evidence of discrimination committed by the ACS worker using
the term “Mexicans” when discussing the case. The Hernandez
case could be a valid concern and should be discussed further
between supervisors.
Diagnosis
V61.20 – Parent-Child Relational Problem (APA, 2013)
Juan Sr admitting to disciplining Juan Jr. in maybe an
inappropriate manner supports the diagnosis. Although there is
no physical abuse, the mental consequences of using book
holding as a punishment could lead to Juan Jr. avoiding books
in school. This avoidance could lead to poor performance in
school later on.
Case formation
ACS has referred this family for investigation of abuse by
the father (Mr. Hernandez) for possible inappropriate
punishment of son (Juan Jr.). Both parents appear to be very
concerned about this accusation and express their concerns and
frustrations appropriately. Both sons are present and appear to
be interacting appropriately without aggression. Mr. Hernandez
discusses attending parenting class as an inconvenience by
having to miss overtime, which is essential to provide for his
family. Mrs. Hernandez expresses concerns about keeping the
family together. Both agree to ACS recommendations of
attending parenting classes.
Treatment Goals
Goals:
Teach safe and effective discipline skills
Teach age appropriate behavior

Teach managing of frustrations
Treatment strategy/interventions:
Positive Parenting Program and family therapy can assist with
attaining set goals for this family.
Estimated completion: 12 weeks
Part 2: Family Genogram

References
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author.

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