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Priya Nair (35), a software engineer, and her husband, Tomás Herrera (37), a high school history teacher, are seen as a couple; Priya made the referral and is the index person. They married in 2019, have no children and make up the Herrera–Nair household.

Presenting problem: their arguments escalated in 2025 over whether to have children and over how much of Priya's time goes to her mother. When they fight, Tomás withdraws for days and Priya pursues, then turns to her mother. Priya has had anxiety since 2020.

Recent changes: Priya's father, Rajesh Nair (1958–2020), an accountant with heart disease since 2012, died suddenly of a heart attack the year after the wedding. He and Lakshmi had married in 1986; she was widowed in 2020. Her mother, Lakshmi Nair (64), a retired pharmacist, moved to a flat two streets away in 2021.

Extended family: Tomás's parents, Miguel Herrera (66), a construction foreman, and Carmen Ruiz (63), a hospital administrator, married in 1987 and divorced in 1999, when Miguel left and Tomás was ten. Carmen raised him alone. Miguel's alcohol misuse began in 1985; he has been sober, in remission, since 2000.

Patterns: Priya and her mother are fused; they speak several times a day. The couple's relationship is hostile. Tomás is distant from his father, and his parents have been cut off from each other since the divorce. Tomás's withdrawal repeats his father's.

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Sophie Marsh (15), a 10th grader, is the index client. She lives in the Mendoza–Bennett household, formed in 2020, with her mother, Laura Bennett (42), a pediatric nurse; her stepfather, Carlos Mendoza (46), a restaurant manager; her brother Ethan Marsh (13), an 8th grader with dyslexia diagnosed in 2020; and her half-sister Lucía Mendoza (4), a preschooler, Laura and Carlos's daughter, born in 2022.

Presenting problem: Sophie was referred for low mood and has had depression since 2025. She refuses to return to her mother's on Sunday nights and says she wants to live with her father. Laura feels Sophie blames her for the divorce.

Recent changes: Sophie's father, David Marsh (44), an electrician, filed in 2025 to change custody; Sophie spends alternate weekends with him. David and Laura married in 2008 and divorced in 2016; Sophie and Ethan are their children. Laura married Carlos in 2020, and since then Carlos has been stepfather to Sophie and Ethan and Laura stepmother to his son, Mateo.

Extended family: Carlos was married to Teresa Vargas (44), a bank teller, from 2006 until their divorce in 2017. Their son, Mateo Mendoza (17), a 12th grader, lives with his mother in the Vargas household; he is Lucía's half-brother.

Patterns: Laura and her ex are hostile. Sophie is close to her dad and hostile with Carlos, who has stopped trying with her, and her relationship with her mum is close but hostile. Ethan, by contrast, is close to his stepfather, which Sophie calls taking sides. Carlos and Mateo have grown distant: Mateo visits his father less since Lucía was born.

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Kaylee Pike (9), a 4th grader, is the index child. Since February 2025 she and her brother Mason (6), a 1st grader, have lived in the Carter foster home, a temporary placement with licensed foster carers Raymond Carter (56), a postal carrier, and Monique Carter (54), a retired teacher, married in 1995. The case is held by Harbor County DCFS.

Presenting problem: Kaylee has had separation anxiety since the removal in 2025; she looked after Mason when her mother was using. Mason has a speech delay, identified in 2023, and settled quickly with the Carters.

Recent changes: the children were removed from their mother, Brittany Pike (née Cole, 29), a part-time cashier with opioid use disorder since 2018, now in remission. In 2025 Brittany moved back in with her mother; the two make up the Cole household. Since the removal she has had supervised contact with Kaylee and with Mason every Saturday. Her case plan asks for clean screens, a parenting class and stable housing. Unsupervised weekend visits start in November 2026, and reunification is targeted for March 2027. The children's father, Jordan Pike (31), a roofer, married Brittany in 2017; they divorced in 2023. He has not attended a visit since June 2025.

Extended family: Brittany's mother, Sharon Cole (56), a home health aide, supervises the Saturday visits. Brittany's father, Dale Cole (1966–2010), a truck mechanic with alcohol misuse from 1985, died of an accidental overdose when she was 13; Sharon had married him in 1993 and was widowed in 2010.

Patterns: Kaylee is her brother's caretaker. She is close to her mother but distant with Monique, while Mason is close to his foster mother. Brittany and Jordan are hostile. Brittany and Sharon are close but hostile.

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Karen Reilly (née Nowak, 60), a school administrator, is the index client, referred by her doctor for caregiver strain; she has had depression since 2025. She lives in the Reilly household with her husband, Brian Reilly (62), an accountant, married in 1990, and her father, Walter Nowak (85), a retired machinist, who has had dementia (Alzheimer's type) since 2022. Karen is his primary caregiver.

Presenting problem: caregiver strain, depression and a fight with her brother over their father's care. Michael wants Walter in memory care and will not share the cost of home care.

Recent changes: Walter moved in with Karen and Brian in 2024. Since then Brian has withdrawn, and the couple rarely talk.

Extended family: Walter married Helen Nowak (née Sobczak, 1944–2019), a homemaker, in 1964. Helen, the family's caregiver and peacemaker, had breast cancer from 2016 and died of it in 2019, leaving Walter widowed. Their children are Karen; Michael Nowak (57), a sales director in Phoenix, Arizona, who visits twice a year; and Steven Nowak (54), a graphic designer. Steven is gay; he married Daniel Ortiz (51), a physical therapist who has never met Walter, in 2015, and they live in Portland, Oregon. Karen and Brian's children are Emily Reilly (32), a registered nurse who covers her grandfather's care on Karen's work days, and Ryan Reilly (29), a line cook who rarely visits.

Patterns: Karen is her father's caretaker, yet Walter is focused on Michael and asks for him every day. Karen and Michael are hostile. Walter cut Steven off when he came out in 2005, and the cutoff stands; Steven offers Karen respite. Karen and Brian are distant, while Emily is close to her mother.

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Linh Tran (16), an 11th grader, is the index client. She lives in the Tran household in Houston, Texas, with her parents and her brother Bao Tran (12), a 7th grader. Both children were born in Houston, Texas, and call themselves Vietnamese American.

Presenting problem: Linh was referred for panic attacks and has had anxiety since 2024. Since she was 10 she has interpreted at the doctor, the bank and parent–teacher meetings, and she misses school to do it.

Her father, Minh Tran (48), a seafood processing worker, was born in Huế, Vietnam, and came to Houston in 2004; he works 60-hour weeks, speaks little English and is a Buddhist who does not practise. Her mother, Mai Tran (née Pham, 45), a nail technician, was born in Da Nang, Vietnam, and came in 2006; she is a practising Catholic, speaks little English and has had depression since 2021. They married in 2008. Both are Vietnamese immigrants.

Recent changes: Minh's mother, Hoa Tran (1953–2021), a market vendor and practising Buddhist, died of COVID-19 during lockdown, and no one from Houston could travel to the funeral. She had married Long Tran (76), a retired fisherman and practising Buddhist, in 1975. Long still lives in Huế, Vietnam, and has had a stroke (2023); Minh sends him money every month as financial support.

Extended family: Mai's parents, Duc Pham (74), a retired tailor, and Lan Pham (71), a retired primary school teacher, are practising Catholics, married in 1977, who live in Da Nang, Vietnam. Lan raised Linh in Da Nang from 2012 to 2016, so Linh has lived in two cultures.

Patterns: Mai is focused on Linh and relies on her to interpret at medical appointments, and Linh is Bao's caretaker; she does his school runs and homework. Linh and her father are hostile and clash over curfew and college. She is close to her grandmother Lan; they video-call every Sunday. Minh and Mai are distant.

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Megan Russo (née Delaney, 34), a dental hygienist, is the index client. Since 2025 she and her children with Tony Russo, Liam Russo (10), a 5th grader, and Ava Russo (7), a 2nd grader, have lived in the Delaney household with her mother, Patricia Delaney (née Byrne, 71), a retired cashier. Megan's eldest, Kayla Bauer (16), an 11th grader, has been in a kinship placement with Sean and Erin, her uncle and aunt, since 2024; she shares a room with their son, Connor Delaney (7), a 2nd grader.

Presenting problem: Megan has had PTSD since 2025. Liam hits out at school and at his mother, and the school has asked for an assessment for suspected ADHD. Ava has had nightmares since witnessing the March 2025 assault. Kayla has had depression since age 14.

Recent changes: Megan married Tony Russo (36), an HVAC technician with alcohol misuse since 2012, in 2014, and Tony became Kayla's stepfather. In 2018 Megan had a miscarriage after Tony pushed her down the stairs. In 2024 Tony hit Kayla; it was the first time anyone called the police, and Kayla was placed with Sean and Erin. In March 2025 Megan left Tony and went to Harbor House shelter. They separated, and in April 2025 a two-year protective order was granted; since then Tony has had supervised contact with Liam and with Ava only. A date convergence: she left ten years to the month after her father's death. Tony moved back into the Russo household with his parents, Sal Russo (76), a retired contractor, and Donna Russo (née Ferraro, 73), a homemaker, married in 1972; Donna calls the order "a misunderstanding". Since 2026 Tony has been dating Jess Marino (29), a bartender, and Megan worries for her. Tony's sister, Gina Russo (33), a hairdresser, takes his side and posts about Megan online.

Kayla's father, Josh Bauer (35), an auto mechanic in Tulsa, Oklahoma, had a brief relationship with Megan from 2009 to 2010, when they were teenagers; he sends birthday cards.

Extended family: Megan's father, Frank Delaney (1952–2015), a steelworker with alcohol misuse from 1975, died of liver cirrhosis in March 2015. He married Patricia in 1974; she was widowed in 2015 and has suspected depression. Megan's brother, Sean Delaney (37), a firefighter, married Erin Delaney (née Kelly, 36), a social worker, in 2017; Erin helped Megan apply for the protective order. Frank's parents, Thomas Delaney (1926–1979), a dock worker with alcohol misuse from the 1950s, and Bridget Delaney (née Doyle, 1929–2012), an office cleaner, married in 1948 and came to the United States as Irish immigrants from Cork, Ireland. Thomas died in a car crash, leaving Bridget widowed in 1979; she died of a stroke, and told her children that what happens at home stays at home. Frank's older sister, Maureen Delaney (77), a retired nurse also born in Cork, Ireland, who came over with her parents, has had cancer in remission since 2019 and is the family's informant: she saw her father beat Frank.

Patterns: violence runs down the male line and into the marriages. Thomas was physically abusive to Frank, Frank to Patricia, and Tony to Megan and, from 2024, to Kayla; Sal is emotionally abusive to Donna. Megan, Tony and Liam form a triangle: Tony is emotionally abusive to Liam, and Liam and his mother are close but hostile. Sean stepped between his parents at 19, in 2008, and was cut off from his father from then on; he is close to Kayla. Megan was cut off from her mother from 2016, when Patricia sided with Tony, until 2025; the cutoff is now repaired. Gina is hostile to Megan.

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Ella Webb (25), a graduate student, is the index client. Since her discharge in September 2026 she has lived in the Webb household with her parents, Sarah Webb (née Lindqvist, 49), an architect, and Marcus Webb (51), a civil engineer, married in 1999; her fraternal twin, Noah Webb (25), a paramedic; and her brother Owen Webb (22), a university student.

Presenting problem: Ella's bipolar disorder began at age 24 with a first manic episode in October 2025, the month of her grandfather's death; a second episode led to an admission to a psychiatric hospital in August 2026. Sarah, who has had depression since 2001, now runs Ella's care. Marcus thinks Sarah smothers her, and the couple fight about her treatment. Noah is unaffected and frightened of becoming ill.

Date convergence: the twins were born in 2001, the year their grandfather, Lars Lindqvist (1952–2001), a music teacher, died by suicide. Lars had bipolar disorder from age 27; his first manic episode came months after a stillbirth in 1979, when he and his wife lost their son Daniel Lindqvist, who is rarely spoken of.

Recent changes: Lars married Judith Lindqvist (née Cohen, 72), a retired school secretary and practising Jew, in 1976; she was widowed in 2001. Their children are Sarah, Daniel and Nathan Lindqvist (44), a bike mechanic whose bipolar disorder also began at age 24, with alcohol misuse from 2003, in remission (sober since 2015). After a manic relapse and a hospitalisation in 2023, Nathan and his son, Leo Lindqvist (14), a 9th grader with anxiety since 2023, moved into Judith's home, a temporary stay that continues. Nathan married Rachel Stein (41), a pharmacy technician, in 2010; they divorced in 2016. Rachel has had opioid use disorder since 2014, and Leo has not lived with her since 2023.

Marcus was married first to Lisa Moreno (52), a dental office manager, from 1995 until their divorce in 1998. Their son, Jake Webb (29), an insurance broker, is Ella's half-brother and Sarah's stepson, and stays out of it.

Extended family: Lars's parents, Erik Lindqvist (1924–1990), a dairy farmer, and Ingrid Lindqvist (née Berg, 1927–2011), a church organist, were Swedish immigrants from Värmland, Sweden, who married in 1949. Erik died of a stroke, leaving Ingrid widowed in 1990; she died of heart failure. Erik had suspected bipolar disorder from the 1950s, never treated: months in bed, then spending sprees that nearly lost the farm. Ingrid kept his spells from the neighbours. Erik's first wife, Astrid Lindqvist (née Nyberg, 1922–1947), a farm worker born in Värmland, Sweden, married him in 1944 and died of tuberculosis in 1947, when their son was one, leaving Erik widowed. That son, Gustav Lindqvist (80), a retired carpenter born in Värmland, Sweden, emigrated with his father and stepmother; he was raised as Ingrid's, told about his mother only at 18, and has had depression since age 40. Lars's older sister, Annika Lindqvist (76), a retired librarian, is the family historian.

Judith's parents, Morris Cohen (1920–1998), a tailor born in Łódź, Poland, and Ruth Cohen (née Adler, 1924–2015), a seamstress born in Kraków, Poland, were Polish Jewish immigrants and practising Jews who married in 1950. Morris survived the camps and never spoke of the war; he died of lung cancer, leaving Ruth widowed in 1998. Ruth had PTSD from 1945 and died of pneumonia.

Patterns: bipolar disorder runs through Erik, Lars, Nathan and Ella. Erik and Lars were hostile. Annika was her brother's caretaker and drove him to hospital in 1979 and 1994. Ruth focused on Judith, her only child, with constant fear; Judith in turn organised her life around Nathan, and the two are close. Lars and Judith were close but hostile, and Sarah, her father's confidante, was close to him and hostile with her mother: a triangle. A generation on it repeats: Sarah is close to Ella, Marcus and Sarah are hostile, and Marcus is distant from Ella. Nathan and Rachel are hostile.

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Jamal Miller (13), an 8th grader with ADHD diagnosed in 2021, is the index client. Since 2023 he has lived in Loretta's kinship home, a temporary placement with his grandmother, Loretta Jackson (60), a certified nursing assistant with diabetes since 2015. With them live his sisters, Aaliyah Miller (16), an 11th grader with anxiety since 2024, and Zoe Miller (9), a 4th grader with asthma since 2019; Zoe's fraternal twin, Zion Miller (9), a 4th grader; and their half-sister, Nevaeh Delgado (2), a toddler, who has had neonatal abstinence syndrome from birth and was placed with Loretta straight from the hospital. Since 2024 Loretta has been the legal guardian of Jamal, Aaliyah, Zoe, Zion and Nevaeh.

Presenting problem: fights at school and a shoplifting charge in 2026. Loretta says Jamal is "just like his father". A date convergence: Jamal was charged at 13, the age his father was at his first arrest, in 1998.

Recent changes: the children's mother, Tasha Miller (née Jackson, 39), unemployed, has had polysubstance use since 2006 and is still using; she lost custody in 2023 after an arrest for possession and misses most visits. She married DeShawn Miller (41), a barber, in 2009, and they separated in 2020. DeShawn has been in state prison since 2022 for drug distribution, with earliest release in 2029. Since 2019 he has had an affair with Keisha Brown (36), a retail manager; their son, Darius Brown (6), a kindergartner, is half-brother to Tasha's children, and Keisha takes him to visit DeShawn in prison. Since 2023 Tasha has lived with her partner, Ray Delgado (43), a day laborer with drug misuse and Nevaeh's father.

Extended family: Loretta married Curtis Jackson (1963–2018), a forklift operator, in 1986. He had alcohol misuse from 1985, drank through his children's childhoods, beat Terrence and died of a heart attack in 2018, leaving her widowed. Tasha's brother, Terrence Jackson (36), a peer recovery coach, had polysubstance use from 2008 and has been in remission since 2021; he attends NA. He married Alicia Jackson (née Reed, 35), an elementary school teacher, in 2018, and in 2022 they adopted Elijah Jackson (11), a 5th grader, from foster care; the three make up the Jackson–Reed household. Loretta's parents are Willie Johnson (1941–1999), a sanitation worker who died of lung cancer, and Hattie Johnson (80), a retired domestic worker; they married in 1964, Hattie was widowed in 1999, and she takes the grandchildren to church every Sunday. DeShawn's parents, Darnell Miller (1961–2004), a bus mechanic, and Bernice Miller (63), a school custodian, married in 1984; Darnell died of a gunshot wound in 2004, when DeShawn was 19, leaving Bernice widowed. Bernice petitioned for custody in 2023 and takes the children to visit their father monthly.

Patterns: Aaliyah is Zoe's caretaker; she parented her while their mother was using. Loretta, Tasha and Jamal form a triangle: Loretta and Tasha are close but hostile, Loretta is focused negatively on Jamal, and Tasha is distant from him. Jamal is close to his father and speaks to him every Sunday. Tasha and Keisha are hostile. Curtis was physically abusive to Terrence, who cut Tasha off in 2024 to protect his sobriety. The two grandmothers, Bernice and Loretta, are hostile, and Hattie is close to Loretta.

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Rohan Patel (26), born in 2000, is the index patient, a software developer. A workplace health check at 25 found an HbA1c of 44 mmol/mol and a BMI of 29, in the prediabetes range, and he has been referred to the diabetes prevention programme. The Patels are a Gujarati family.
His father, Arjun Patel (55), born 1971, is an IT project manager. He was diagnosed with type 2 diabetes at 46 after an HbA1c of 58 mmol/mol and with hypertension at 49, and takes metformin and a statin. Rohan is close to his dad. His mother, Meera Patel (née Shah, 52), born 1974, is an accountant; she had gestational diabetes in her first pregnancy, at 26, which resolved after delivery and is in remission, and her yearly HbA1c has been normal since. Arjun and Meera married in 1998.
They have three children: Rohan; Anika Patel (23), born 2003, a university student with irregular cycles and raised androgens, in whom polycystic ovary syndrome has been suspected since 21 and a pelvic ultrasound is pending; and Dev Patel (17), born 2009, a school student with a normal fasting glucose at a school sports medical and no conditions. Arjun, Meera, Anika and Dev share a household; Rohan lives elsewhere.

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Leah Goldberg (32), born 1994, a primary school teacher, is the index patient, seen at her six-week postnatal check after her first birth. Her EPDS score was 17 and postpartum depression was diagnosed at 32; she has started sertraline and been referred to the perinatal mental health team. She had anxiety at 19, now in remission.
Leah married Daniel Kim (34), born 1992, a civil engineer, in 2022; he scored 3 on the PHQ-9 when screened at the same visit. They live with their son, Eli Kim, born in 2026 at 39 weeks by emergency caesarean section, who is feeding and growing well.
Leah's mum, Ruth Goldberg (64), born 1962, is a retired librarian. Ruth was treated for postpartum depression after Leah's birth, at 32, now in remission, and has had major depressive disorder since 48, for which she takes long-term venlafaxine. Ruth and Leah are close. Leah's younger sister, Talia Goldberg (29), born 1997, is a graphic designer diagnosed with bipolar II disorder at 21 after a hypomanic episode at university; she is stable on lamotrigine.
Daniel's mother, Grace Kim (65), born 1961, is a retired pharmacist with no psychiatric history. She comes over most days to cook and mind Eli so that Leah can sleep, and is Leah's caretaker.

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Conor Doyle (41), born 1985, a secondary school teacher, is the index patient, referred to the lipid clinic with an LDL of 6.1 mmol/L and corneal arcus at 39. His Dutch Lipid Clinic score is 8 (probable FH), so familial hypercholesterolaemia is suspected; a genetic test is pending.
His father, Brian Doyle (1960–2008), was a bus driver who had been smoking since 16. He had his first myocardial infarction at 41, with a total cholesterol of 8.9 mmol/L, and died of a second myocardial infarction at 48. Brian married Teresa Doyle (née Walsh, 64), born 1962, a school secretary, in 1983; she reports no cardiac history in her own family. Conor's sister, Aoife Doyle (38), born 1988, is a staff nurse who has smoked ten a day since 16 and has never had her lipids checked.
On the paternal line, Brian's father, Patrick Doyle (1936–1979), a dock worker who smoked thirty cigarettes a day from 14, died suddenly at work of a myocardial infarction at 43. Patrick married Maureen Doyle (née Byrne, 86), born 1940, in 1959; she is a retired shop assistant with hypertension since 62, well controlled on amlodipine. Their other children are Kevin Doyle (63), born 1963, an electrician with coronary artery disease since 52, when he had two stents in 2015 (he smoked from 15, stopped that year and is in remission, and takes high-dose atorvastatin), and Siobhan Doyle (60), born 1966, a pharmacist with hypercholesterolaemia since 45, LDL 5.6 mmol/L at diagnosis, on a statin with no cardiac events. Siobhan is Maureen's caretaker, and the two live together.

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Ama Mensah (11), born 2015, is the index patient. She has had asthma since 3, with two hospital admissions for exacerbations, and takes a daily inhaled corticosteroid and montelukast; she has also had atopic eczema since 1. Her identical twin, Abena Mensah (11), also born 2015, has had no wheeze, eczema or allergy to date. The twins are close. Their brother, Yaw Mensah (14), born 2012, has had a peanut allergy since 1 and carries adrenaline auto-injectors; asthma has been suspected since 13 because of exercise-induced wheeze, and spirometry is booked.
Their father, Kofi Mensah (43), born 1983, an accountant, had asthma from 4 and outgrew it by 14, so it is in remission; he has had allergic rhinitis since 12, with hay fever every summer. Their mum, Emma Mensah (née Clarke, 42), born 1984, a physiotherapist, has had atopic eczema on her hands since 1, managed with emollients. Kofi and Emma married in 2010 and live with all three children.
Kofi's older sister, Efua Mensah (47), born 1979, is a pharmacist with asthma since 7 that persisted into adulthood, and allergic rhinitis with a grass-pollen allergy since 7. Their parents both emigrated from Ghana and married in 1976. Kwabena Mensah (1948–2019) was a lorry driver with a forty-year smoking history from 18; he developed COPD at 62 and died of an infective exacerbation of COPD. Akosua Mensah (74), born 1952, a retired midwife, has had adult-onset asthma since 34, controlled on a preventer inhaler.

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Mateo Herrera (27), born 1999, a warehouse supervisor, is the index patient. His AUDIT score is 19 with morning drinking, so alcohol use disorder is suspected, starting at 24; he has had anxiety since 20. He moved back in with his father in 2025 and the two now share a household.
His father, Miguel Herrera (57), born 1969, is an auto mechanic whose alcohol use disorder began at 19. He has been sober since 2012 after residential treatment, is in remission, and attends AA weekly. Miguel married Karen Olsen (55), born 1971, a dental hygienist, in 1994; his ex-wife divorced him in 2010, during his heaviest drinking. Their children are Sofia Herrera (30), born 1996, a registered nurse who drinks rarely (AUDIT score 2), and Mateo.
Miguel's father, Ernesto Herrera (1944–2008), was a construction foreman with alcohol use disorder from 20 who drank daily and never accepted treatment; he developed cirrhosis at 61 and died of alcohol-related cirrhosis. Ernesto married Dolores Herrera (née Ruiz, 79), born 1947, a retired seamstress, in 1966; she has had depression since 50 and lives alone. Their other children are Javier Herrera (54), born 1972, a roofer with alcohol use disorder since 17, still drinking, with two drink-driving convictions, who has refused treatment; and Carmen Herrera (50), born 1976, a social worker who does not drink. Miguel and Javier have been cut off from each other since 2015. Carmen is her mother's caretaker and manages her appointments and medicines.

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Rachel Weiss (37), born 1989, a speech therapist, is the index patient: an unaffected BRCA2 carrier found on cascade testing in 2022. She had a risk-reducing bilateral mastectomy in 2024 and plans a risk-reducing salpingo-oophorectomy at 40–45. She married Kenji Tanaka (39), born 1987, a chef of Japanese heritage with no family history of cancer, in 2013; they live with their daughter, Lily Tanaka (11), born 2015, who is at 50% risk, with predictive testing deferred until she is 18. Rachel is close to her older sister, Hannah Weiss (40), born 1986, a solicitor, who had ER-positive breast cancer at 36, treated with bilateral mastectomy and chemotherapy and now in remission; Hannah's BRCA2 pathogenic variant was found in 2022.
Paternal side: their father, David Weiss (64), born 1962, a chartered surveyor, tested positive as a BRCA2 carrier in 2022 after Hannah's result, and prostate cancer was found on PSA screening at 63; he is on active surveillance. His sister, Miriam Klein (née Weiss, 1957–2011), a music teacher, had stage IIIC high-grade serous ovarian cancer at 50, was never tested, and died of it. She married Alan Klein (71), born 1955, a retired architect with no cancer history, in 1985, and they adopted Noah Klein (32), born 1994, a data analyst, as a baby in 1994; he is not a blood relative. Their brother, Jonathan Weiss (66), born 1960, an optometrist, tested negative for the family variant in 2022. Their father, Samuel Weiss (1929–2004), a tailor, had male breast cancer at 67, treated by mastectomy in 1996, then pancreatic cancer at 74, which killed him. He married Esther Weiss (née Rosen, 92), born 1934, a retired bookkeeper with no cancer history, in 1955. Both Samuel and Esther are of Ashkenazi Jewish heritage.
Maternal side: Rachel's mother, Maria Weiss (née Santos, 62), born 1964, a retired nurse, has no cancer history; David and Maria married in 1984. Maria's parents, António Santos (89), born 1937, a retired fisherman with no cancer history, and Fernanda Santos (née Costa, 86), born 1940, a retired cook, married in 1961; all three are Portuguese. Fernanda had postmenopausal, hormone-receptor-positive breast cancer at 74, treated with lumpectomy and letrozole, now in remission.

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Lucy Novak (32), born 1994, a dietitian, is the index patient. She is at 50% risk of Huntington's disease and untested, and is 30 weeks pregnant, due in December 2026; the pregnancy carries a 25% prior risk while Lucy is untested. She has been referred for genetic counselling about predictive testing. She married Tomás Reyes (35), born 1991, a physiotherapist, in 2021; he supports her decision to wait for counselling before testing.
Lucy is close to her younger brother, Jakub Novak (29), born 1997, a chef on sick leave, who developed Huntington's disease at 27 with chorea and clumsiness; he has 51 CAG repeats, expanded through paternal transmission. Their father, Pavel Novak (61), born 1965, a retired electrician, has had Huntington's disease since 49 with 43 CAG repeats and now needs help with walking and eating. Pavel married Sarah Novak (née Whitfield, 60), born 1966, a practice manager, in 1992; she is his full-time caretaker, the two live together, and she has been treated for depression since 55.
Pavel's father, Josef Novak (1941–2012), a machinist, had late-onset chorea at 62 with 40 CAG repeats and died of aspiration pneumonia at 71. Josef married Helena Novak (née Kral, 82), born 1944, a retired bank clerk with no neurological history, in 1963; both are of Czech heritage. Their other children are Martin Novak (58), born 1968, a postman who is untested and in whom Huntington's disease has been suspected since 56, after his GP noticed mild chorea and irritability, though he has declined referral; and Eva Hughes (née Novak, 55), born 1971, an occupational therapist whose predictive test in 2009 was negative (17 and 20 CAG repeats). Eva married Peter Hughes (57), born 1969, a firefighter who married into the family and is not at risk, in 1997; their son, Oliver Hughes (27), born 1999, a paramedic, is not at risk because his mother tested negative.

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Erik Virtanen (47), born 1979, a software architect, is the index patient. He was diagnosed with colorectal cancer at 46 and is having adjuvant chemotherapy; his tumour showed loss of MLH1 and PMS2 without MLH1 promoter hypermethylation, and germline testing confirmed him as an MLH1 carrier in 2025. He was born in 1979, the year his grandfather Eino died of colorectal cancer. Erik married Mei Lin Chen (46), born 1980, an architect with no cancer history, in 2007. They live with their fraternal twins, Leo Virtanen and Mia Virtanen (16), both born 2010 and both school students, who are at 50% risk; MLH1 testing will be offered at 18 and colonoscopy from 25. Erik is close to his mother and distant from his father.
Erik's parents are Matti Virtanen (72), born 1954, a retired civil engineer, and Debra Collins (70), born 1956, a hospice nurse. They married in 1977 and divorced in 1988, and their relationship is still hostile. Debra had depression from 32, after the divorce; it is in remission. Matti had colorectal cancer at 41, treated by right hemicolectomy and now in remission, and urothelial cancer of the left ureter at 70, which is under treatment; he was confirmed as an MLH1 carrier in 2025. In 1990 Matti married Sandra Virtanen (née Barrett, 67), born 1959, a bookkeeper. Matti and Sandra are close and live together; Sandra and Debra are hostile to each other. Their daughter, Anna Virtanen (35), born 1991, a veterinary nurse, is Erik's half-sister and close to him. She tested positive as an MLH1 carrier in 2025, a colorectal adenoma was removed at her first colonoscopy at 34, and she has had anxiety since 34.
Sandra was first married to Gary Mills (70), born 1956, a scaffolder, from 1982 until their divorce in 1987. Gary has had alcohol use disorder since 20 and has been cut off from their son since 1987. That son, Jordan Mills (42), born 1984, a chef, is Anna's half-brother and Erik's stepbrother, and is not a blood relative of the Virtanens. Jordan has had alcohol use disorder since 19; he has been sober since 2019, so it is in remission, and he attends AA. Sandra watches him closely for relapse. Jordan has lived with Kayla Reed (38), born 1988, a care assistant, since 2014. Kayla has had depression since 28, the year their daughter Ava Mills (10) was born, in 2016. Ava, a school student, is awaiting an assessment for ADHD, suspected since 8. The three live together.
Matti's parents both emigrated from Finland in 1954. His father, Eino Virtanen (1926–1979), a carpenter, had colorectal cancer at 47 and died of metastatic colorectal cancer at 53. His mother, Aino Virtanen (née Laine, 1929–2017), a homemaker, married Eino in 1950 and was widowed in 1979. In 1984 she married Walter Brooks (1921–2009), a retired postal worker, and was widowed again when he died of a stroke at 88. Aino developed dementia at 81 and died of it in 2017; her daughter Liisa was her caretaker until then.
Matti's sister, Liisa Mäkelä (née Virtanen, 74), born 1952, a retired teacher, had endometrial cancer at 48, treated by hysterectomy and in remission, and was confirmed as an MLH1 carrier in 2025. She married Pekka Mäkelä (77), born 1949, a retired paper-mill technician with no cancer history, in 1975. Their son, Mikko Mäkelä (43), born 1983, a logistics manager, tested negative for the family MLH1 variant in 2025. Mikko lived with Chloe Martin (41), born 1985, a hairdresser, from 2014 until they separated in 2024, and the separation is hostile. Their son, Oskar Mäkelä (9), born 2017, a school student, is not at risk because his father tested negative. Since 2024 Mikko and Oskar have been living with Pekka and Liisa as a temporary arrangement.

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Desmond Campbell (65), born 1961, a train driver, is the index patient, referred to the cardiometabolic clinic. He has had type 2 diabetes since 47, with an HbA1c of 71 mmol/mol on metformin and empagliflozin, and had a myocardial infarction at 58, stented in 2019.
Desmond's parents came from Jamaica. His father, Winston Campbell (1934–1999), a bus driver, arrived in 1958; he had hypertension from 40, poorly controlled for years, and died of a haemorrhagic stroke at 65. His mother, Gloria Campbell (née Brown, 88), born 1938, a retired nurse, followed in 1960. Winston and Gloria married in 1957, and she was widowed in 1999. Gloria has had hypertension since 50, type 2 diabetes since 52 and chronic kidney disease since 80, and has been on haemodialysis since 2024. In 2003 she married Clive Thompson (1935–2021), a retired carpenter; they were close until he died at 86 of heart failure, which he had had since 80, and she was widowed again in 2021.
Desmond's first marriage, to Paulette Grant (63), born 1963, a school administrator, lasted from 1988 until their divorce in 1996, and the two are still hostile. Paulette had gestational diabetes at 27, when pregnant with their daughter, and depression at 33, around the divorce; both are in remission. That daughter, Kezia Campbell (36), born 1990, a radiographer, is close to her mother and distant from her father. Kezia has lived with Jerome Baptiste (38), born 1988, a sound engineer with no cardiometabolic history, since 2019. They had a miscarriage in 2021. When expecting their daughter, Naomi Baptiste (3), born at term in 2023, Kezia had gestational diabetes at 33; it resolved after the birth, so it is in remission, and yearly HbA1c checks have been advised.
In 1998 Desmond married Fiona Campbell (née Ross, 62), born 1964, a Scottish practice nurse; they are close and live together, while Fiona and Paulette keep their distance from each other. Fiona started smoking at 16 and stopped in 2008, so it is in remission. She had been widowed in 1994: her first husband, Rory Douglas (1958–1994), a Scottish joiner whom she married in 1990, collapsed while playing football and died of sudden cardiac death at 36, and hypertrophic cardiomyopathy was found at post-mortem. Their son, Jamie Douglas (34), born 1992, a software tester, is Desmond's stepson, and the two have a hostile relationship. A screening echocardiogram at 30 showed a septal thickness of 14 mm, so hypertrophic cardiomyopathy is suspected and genetic testing is pending; Fiona is anxious and focused on his results. Desmond and Fiona's son, Callum Campbell (27), born 1999, the year his grandfather Winston died, is a delivery driver with prediabetes since 25 (HbA1c 45 mmol/mol); he is close to his half-brother Jamie.
Desmond's sister, Marcia Adebayo (née Campbell, 60), born 1966, a head teacher, has had type 2 diabetes since 45; it has been in remission since bariatric surgery in 2018. She is her mother's caretaker and drives her to dialysis. In 1991 Marcia married Tunde Adebayo (64), born 1962, a civil servant who emigrated from Nigeria in 1985 and has had hypertension since 50. Their daughter, Bisi Adebayo (33), born 1993, a junior doctor, had a normal blood pressure and HbA1c at her last check. Their son, Kunle Adebayo (30), born 1996, an electrician, has been smoking ten a day since 17 and has been offered stop-smoking support. Since 2023 Marcia and Tunde have fostered Jayden Cole (15), born 2011, a school student who has had obesity since 12 and attends a healthy-weight clinic; Marcia is close to him, and the three live together as a foster placement. Kunle married Priya Nair (29), born 1997, a dentist with no cardiometabolic history, in 2020; they live with their daughter, Zara Adebayo (5), born 2021, whose development checks are normal.

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Mia Pike, born in 2016, is the index child and a primary school pupil. Her maternal grandparents are Robert Brennan (born 1961), a retired firefighter with heart disease diagnosed in 2019, and Denise Brennan (née Walsh, born 1963), a school administrator; they married in 1988. In 2020 the family court made both grandparents Mia's legal guardians, so Robert and Denise each hold legal guardianship of Mia, and she has been in their care ever since.

Robert and Denise have two children. Ethan Brennan (born 1993) is an electrician. Kayla Brennan (born 1996) is a retail cashier with drug misuse that began in 2018; she is now in recovery. Ethan cut off contact with his sister Kayla when Mia went into their parents' care, and they have not spoken since.

Kayla lived with Jordan Pike (born 1994), a warehouse operative with alcohol misuse, from 2015 until they separated in 2019; Mia is their only child. Under the court order Kayla has supervised contact with Mia every Saturday at a family contact centre, supervised by a contact worker. Jordan is distant from Mia and has not asked the court for any contact. The guardians want to know whether Kayla's recovery is enough to move towards unsupervised visits.

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Rachel Ortiz (née Reyes), born in 1987, is the client. She is a part-time dental hygienist with depression diagnosed in 2023, the year her divorce was finalised. She married Daniel Ortiz (born 1985), a software engineer, in 2012, and they divorced in 2023; their relationship is still hostile. Their son Leo Ortiz, born in 2015, is an elementary school student, and Rachel and Leo are close. Daniel pays child support: he gives Leo financial support every month.

Rachel's parents are Manuel Reyes (born 1957), a retired accountant with diabetes since 2012, and Carmen Reyes (born 1959), a real estate agent; they married in 1984. Since 2023 Manuel has given Rachel monthly financial support that covers her rent and Leo's after-school care. Carmen and Manuel have a close-hostile relationship: they are close, but they argue about the money and whether it keeps Rachel from standing on her own.

Rachel's younger brother, Andrés Reyes (born 1990), is a firefighter. In 2023 he signed Rachel's apartment lease with her; the co-signed lease makes Andrés liable if she misses a payment. Rachel wants to stop depending on her father within two years without losing the apartment.

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Walter Brandt (born 1944) founded Brandt Precision Tooling and is still its chairman. He married Ingrid Brandt (née Vogel, born 1947), the firm's retired bookkeeper, in 1968. Walter has heart disease; after a heart attack in 2015 he stepped back and gifted shares to his two children. Karl owns shares and Heidi owns shares in the company alongside Walter, who kept the controlling block.

Karl Brandt (born 1970) has been chief executive since 2015 and is the advisor's main contact. His wife, Susan Brandt (née Park, born 1971), is an HR consultant; they married in 1996. Susan worries about Karl's drinking, and he has suspected alcohol misuse. Heidi Nolan (née Brandt, born 1973) is chief financial officer and has anxiety. She married Paul Nolan (born 1972), a high school teacher, in 1999. The rivalry between Karl and Heidi over who should lead the company after Walter is openly hostile.

In the third generation, Lukas Brandt (born 1998), Karl and Susan's son, is the operations manager: Karl employs Lukas, who joined the firm in 2020. Emma Nolan (born 2000), Heidi and Paul's daughter, is a manufacturing engineer at another company. Walter mentors Emma every week and sees her as the natural successor. Heidi and Emma are fused; they talk several times a day and Heidi tells her about every board discussion. The family has asked for help agreeing on a succession plan before Walter's next birthday.

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Jayden Webb (born 2014), an elementary school student with ADHD, is the index child. He and his sister Aaliyah Webb (born 2011), a middle school student with anxiety, were removed from their mother's care in 2024 and placed in kinship care with their maternal aunt and uncle. Keisha Morgan (née Carter, born 1984), a transit dispatcher, and her husband Darnell Morgan (born 1982), a postal carrier, married in 2008; the four of them have formed a temporary household since 2024.

The children's mother, Tanya Carter (born 1990), is unemployed and has drug misuse that began in 2019. Their father, Marcus Webb (born 1988), a former line cook, lived with Tanya from 2010 until they separated in 2022, when he was incarcerated; he is distant from Jayden and writes to him only now and then. Tanya has court-ordered visitation with Aaliyah and with Jayden twice a month at the agency office. Keisha and Tanya are sisters, and Keisha has cut off contact with Tanya since the removal.

The sisters' parents are Raymond Carter (1958–2015), a bus mechanic who died of heart disease, and Gloria Carter (born 1961), a home health aide with diabetes; they married in 1981 and Gloria was widowed in 2015. Gloria is close to Keisha and does the school pickups. Elena Ruiz (born 1979) is the county child welfare case manager; she has case manager contact with Jayden every month and reports to the court on the placement.

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Harold Whitfield (born 1938), a retired machinist, has dementia diagnosed in 2021 and is the person the care plan is built around. He has been married since 1962 to Dorothy Whitfield (née Lane, born 1941), a retired school secretary with heart disease diagnosed in 2018; the two of them still live in the family home. Since 2023 Marisol Duarte (born 1980), a home care aide from an agency, has been Harold's paid carer every weekday morning.

Harold and Dorothy have four adult children in three households. Ellen Price (née Whitfield, born 1964), a registered nurse, married Tom Price (born 1962), an accountant, in 1989, and they live together; their daughter Hannah Price (born 1992) is a physical therapist. Ellen has held power of attorney for Harold since 2022. David Whitfield (born 1966), a sales engineer, lives out of state with his wife Grace Whitfield (née Kim, born 1968), a teacher, whom he married in 1995; their son Owen Whitfield (born 1998) is a software developer. David gives Harold financial support that pays for the agency hours.

Carol Whitfield (born 1969), a librarian, and her younger brother Brian Whitfield (born 1972), a delivery driver with alcohol misuse, share a house. Carol lives nearby, five minutes from Dorothy, and is Harold's main family caretaker in the evenings. Brian and Dorothy have a close-hostile relationship: they speak every day and argue about his drinking. The family wants a plan that does not rest on Carol alone.

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Sophie Marsh (born 2010), a high school student and competitive swimmer, is the client. She has had anxiety since 2021, the year her grandfather died, and a suspected eating disorder was first noticed in 2025. She lives with her parents, Kevin Marsh (born 1976), an airline pilot, and Laura Marsh (née Doyle, born 1978), a corporate attorney with anxiety, who married in 2007. Kevin and Laura's relationship is hostile; they argue about Sophie's training while he is away four nights a week. Laura and Sophie are fused: Laura checks Sophie's meals and messages, and Sophie rarely decides anything without her.

Laura's parents were Frank Doyle (1949–2021), a retired police officer who died of heart disease, and Helen Doyle (born 1952), a retired nurse; they married in 1974 and Helen was widowed in 2021. Helen and Laura are close. Laura's sister, Megan Doyle (born 1981), a graphic designer, married Priya Shah (born 1980), a veterinarian, in 2016.

Outside the family, four people matter to Sophie. Her swim coach, Dana Whitaker (born 1987), puts pressure on her to make the qualifying time and runs weekly weigh-ins. Her school counsellor, Jamal Reed (born 1983), is a steady support and meets her every week. Her best friend, Ava Torres (born 2010), also a high school student, is her main support among friends. Nathan Hughes (born 1991), the youth pastor at the family's church, is a mentor to Sophie.

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This is a multi-agency child-welfare case with four generations. The index child is Jada Mendes.

Jada Mendes and her fraternal twin brother, Jalen Mendes, were born in 2012 to Ashley Dawson (born 1991) and Luis Mendes (born 1988). Both twins are 8th grade students. Jada has suspected anxiety, first noticed in 2024, and has long been Jalen's caretaker; Jalen has ADHD, diagnosed in 2019. Luis, a line cook, is an immigrant from Recife, Brazil. He and Ashley lived together from 2011 until they separated in 2017, and their relationship is hostile.

Ashley is unemployed. She has drug misuse that began in 2016 and depression since 2019. From 2018 she lived with Tyler Briggs (born 1990), a roofer with suspected drug misuse; they separated in 2022. Ashley and Tyler had a miscarriage in 2019, and their daughter Lily Briggs was born in 2020, making Lily the twins' half-sister. Lily is a preschool pupil with a speech delay identified in 2023. Tyler is distant from Lily. Ashley is now in residential treatment at Riverside Recovery Center.

The children were removed in 2024. The twins were placed in a temporary kinship household with their maternal aunt, Brenda Kowalski (née Dawson, born 1986), a medical receptionist, and her husband, Mike Kowalski (born 1984), an HVAC technician; they married in 2010. Mike is focused negatively on Jalen and blames him for the strain on the household. Lily was placed in foster care in 2024 with Martin Pruitt (born 1974), a civil engineer, and Gail Pruitt (born 1976), a foster carer and former teacher, who married in 2001. Their son Caleb Pruitt (born 2006) is a college student, and their daughter Hope Pruitt (born 2014), a 6th grade student, joined the family by adoption in 2016. Lily is close to Gail.

Brenda and Ashley's parents are Ray Dawson (born 1958), a long-haul trucker with alcohol misuse that began in 1978 and is now in recovery, and Linda Fisher (née Walsh, born 1960), a school bus driver with diabetes since 2015. Ray and Linda married in 1984 and divorced in 1995, and they are still hostile. In 1998 Linda married Gary Fisher (born 1956), a retired electrician, who is Ashley's stepfather; Linda and Gary live together. Linda and Gary are close, Gary and Ashley are hostile, and Linda and Ashley are close-hostile, so Linda is caught in a triangle between her husband and her daughter. Linda gives Brenda monthly financial support towards the twins' costs.

Linda's parents were Frank Walsh (1932–1998), a steelworker who died of heart disease diagnosed in 1990, and Irene Walsh (née Byrne, 1935–2019), a homemaker with dementia from 2013. They married in 1954, and Irene was widowed in 1998. Irene and Linda were close.

The agencies and the court. Since 2025 Ashley has had supervised contact with Jada, with Jalen and with Lily every other Sunday at Riverside, supervised by agency staff. Since 2024 Luis has had court-ordered visitation with Jada and with Jalen on alternate weekends. Renee Adler (born 1982), the county child welfare case manager, has had case manager contact with Brenda every month since 2024. Marcus Bell (born 1979), the middle school counsellor, is a support for Jada and sees her every week.

Date convergence: Irene died in the spring of 2019, Ashley's miscarriage followed weeks later, and both Ashley's depression and Jalen's ADHD diagnosis date from that same year.

The team must decide whether Ashley's progress supports reunification with all three children, and whether Lily can be placed with her half-siblings.

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Moreau Fine Foods is a four-generation family company. Laurent Moreau, the chief executive, is the client, and his claim to the succession is being contested.

The founders were Henri Moreau (1922–2004) and Claire Moreau (née Dubois, 1926–2011), who married in 1948. Both were immigrants from Lyon, France. Henri had heart disease diagnosed in 1990 and died of it in 2004; he was focused negatively on his son Philippe all his life. Claire had cancer in 1996 that went into remission, and she was close to her daughter Juliette. Henri set up the Moreau Family Trust.

Philippe Moreau (born 1950) is the chairman. He married Margaret Moreau (née Ellis, born 1952), a former interior designer, in 1975. They separated in 2024, and their relationship is hostile. Since 1988 Philippe has had an affair with Elena Vasquez (born 1962), a restaurant owner, and he has paid her secret financial support every month since 1988. Their son, Daniel Vasquez (born 1990), is vice president of sales, and Elena and Daniel are close. In 2020 Philippe gave Daniel shares, so Daniel owns shares in the company, which Laurent disputes. Philippe had a stroke in 2024 and has suspected alcohol misuse. Since the stroke he has been staying, as a temporary arrangement, with Elena and Daniel.

Philippe and Margaret have two children. Laurent Moreau (born 1977) has been chief executive since 2019, and his anxiety dates from that year. Margaret and Laurent are fused, while Philippe and Laurent are close-hostile, so Laurent sits in a triangle with his parents. Laurent and his half-brother Daniel are hostile rivals for the succession. Laurent married Anika Moreau (née Rao, born 1979), a cardiologist, in 2003. Their identical twin sons, Theo Moreau and Lucas Moreau, were born in 2005, and the twins are close. Laurent employs Theo as a management trainee, a job he started in 2025, while Lucas is a university student. Their daughter Ava Moreau (born 2012) is a middle school student, and Laurent, Anika and Ava live together.

Sophie Moreau (born 1980), Laurent's sister, is a documentary producer. She had an eating disorder from 1995 that is now in remission. She has been cut off from Philippe since 2012 but is close to her half-brother Daniel. Juliette is the trustee of the Moreau Family Trust and pays Sophie her distributions, so the trustee line runs from Juliette to Sophie.

Juliette Grant (née Moreau, born 1953), Philippe's sister, is a retired lawyer who holds the other half of the company. She married Robert Grant (born 1951), a retired surgeon, in 1978. Their daughter Nicole Grant (born 1981) is chief financial officer. In 2018 Juliette transferred shares to Nicole, so Nicole owns shares too. Nicole has had depression since 2014. She married Mark Hollis (born 1979), a commercial pilot, in 2006, and they divorced in 2014; they are still hostile. Their daughter Chloe Hollis (born 2008) is a high school student. In 2017 Nicole married Ben Adeyemi (born 1980), a software architect, who is Chloe's stepfather. Their son Leo Adeyemi (born 2019), Chloe's half-brother, is a 1st grade student with ADHD diagnosed in 2025. Nicole, Ben, Chloe and Leo live together.

Outside the family, Grace Lin (born 1965), the chief operating officer and the first non-family executive, has been a mentor to Daniel since 2021 and is preparing him for the top job.

Date convergence: Henri died in 2004, the year Margaret first learned about Daniel at Henri's funeral; her depression dates from that same year.

The board wants a succession plan that Juliette and Nicole, who hold the deciding votes, can support before Philippe's health forces the question.