Early Childhood Developmental Social and Family History

Once again, it is helpful to begin with the less affect-laden material, such as age, date ofbirth, and place of birth. Open-ended questions such as "What was it like for you growing up?'' and "Who was in your family when you were growing up?'' may be ways to begin. Exploration of relationships with parents, siblings, and other family members as well as discussions about parental drug and alcohol use can follow. Family history also includes information about illness patterns, particularly psychiatric illnesses such as bipolar disorder or schizophrenia. History and chronology of early childhood losses are highly significant and deserve careful interest and documentation. Educational history includes the following questions and is relevant in determination of current level of intellectual and occupational function: (1) "How far did you go in school?'' (2) "How did you do in school?'' (3) "What was school like for you?'' (4) "Were there any problems with learning?''

A thorough housing history includes questions about where the patient lives, whether the patient lives alone or with others, and whether the patient is homeless or marginally housed. Specific information about housing includes whether the patient is in his or her own apartment or home, if the patient is comfortable and has space, privacy, an elevator if mobility is compromised, heat, and hot water, and if the home is free of rodents or other pests. Persons who live in marginal housing, in shelters, or on the street may feel embarrassed to discuss these issues and may not disclose this information as a result.

Family history includes information about family of origin as well as relational history with partners. Since it is hard to suffer an illness in silence, it is important to ask whether the patient has disclosed his or her serostatus to anyone in the family or to any partners. Disclosure may be easier for some patients and difficult to near impossible for other patients. The multidimensional determinants in considerations of disclosure include relational, psychological, social, cultural, spiritual, and political factors. Fear of disclosure to aged parents is often used as a reason for not telling any family member about serostatus.

Ages and health status ofparents or dates and causes of death along with number, ages, and health of siblings are relevant. History of medical or mental illnesses and impact on the patient are also significant. Relational history includes information about past and current partners and whether the patient is in a relationship. Allowing the patient to discuss the relationship is important. Such discussions should include questions about disclosure of serostatus to his or her intimate partner. It is important to ask for the number, names, ages, health, and whereabouts of children, if any, along with the status of the parent-child rela tionship. The complex issues of whether and when to disclose to children are relevant. Dialogue about disclosure can begin during history-taking.

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