33010802 tools-for-family-assessment

TOOLS IN FAMILYTOOLS IN FAMILY
ASSESSMENTASSESSMENT

 Patient coming in to the clinic with healthPatient coming in to the clinic with health
problemproblem cannot be fully understoodcannot be fully understood if only theif only the
pathophysiology of medical problem ispathophysiology of medical problem is
consideredconsidered
 Family relationship + family social system +Family relationship + family social system +
family cultural system = better evaluation &family cultural system = better evaluation &
better health carebetter health care
 Family systemsFamily systems approach toapproach to common clinicalcommon clinical
situation can facilitate a new levelsituation can facilitate a new level ofof
understanding of patient’s problemunderstanding of patient’s problem
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

Steps in Incorporating FamilySteps in Incorporating Family
Systems Approach intoSystems Approach into
Clinical PracticeClinical Practice
 STEP 1STEP 1
RECOGNIZE FAMILYRECOGNIZE FAMILY
STRUCTURESTRUCTURE

RECOGNIZING FAMILYRECOGNIZING FAMILY
STRUCTURESTRUCTURE
 know individuals in the familyknow individuals in the family
 names, place of residence, specific rolesnames, place of residence, specific roles
in the family, stage of family in family lifein the family, stage of family in family life
cycle, significant dates in the familycycle, significant dates in the family
 complete a family genogramcomplete a family genogram

FAMILY GENOGRAMFAMILY GENOGRAM
 Very excellent tool in learning about familyVery excellent tool in learning about family
structurestructure
 Records names and roles of each member ofRecords names and roles of each member of
the familythe family
 Separates extended family into severalSeparates extended family into several
householdhousehold
 Documents medical problems of each memberDocuments medical problems of each member
of the familyof the family
 Documents significant dates in the family historyDocuments significant dates in the family history

FAMILY GENOGRAMFAMILY GENOGRAM
 Graphic representation of followingGraphic representation of following
components of a family:components of a family:
1. Family Tree1. Family Tree
2. Functional Chart2. Functional Chart
3. Family illness/History3. Family illness/History

malemale deathdeath
femalefemale index patientindex patient
spontaneous abortionspontaneous abortion marital discord & GFmarital discord & GF
pregnancypregnancy adoptedadopted
cause of deathcause of death marriage and yearmarriage and year
separation & yearseparation & year not marriednot married
conflictual relationshipconflictual relationship distant relationshipdistant relationship
close relationshipclose relationship overly closeoverly close
dominant relationshipdominant relationship marital discordmarital discord
A
2005
1968

FAMILY TREEFAMILY TREE
 Must contain 3 or more generations, each
identified by a Roman numeral
 1st
born of each generation is farthest to
left, with siblings following to right in order
of birth
 Family name placed above each major
family unit
 Given names and ages are placed below
each symbol
 One member of family is of greater
medical significance because of an illness
(index patient, identified with an arrow)
 Date is indicated when chart was
developed so ages would be adjusted over
time Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

FUNCTIONAL CHARTFUNCTIONAL CHART
 Gives a moreGives a more dynamic imagedynamic image of familyof family
 Allows one to judge totality of family unitAllows one to judge totality of family unit
(strengths & weaknesses, ability to(strengths & weaknesses, ability to
withstand future stressful situations)withstand future stressful situations)

FAMILYFAMILY
ILLNESS/HISTORYILLNESS/HISTORY
 Denotes presence of inherited diseases orDenotes presence of inherited diseases or
familial tendencies indicating potentialfamilial tendencies indicating potential
problems in the familyproblems in the family

Ben,43
1942
Maria,7
8
2003
Salvador,6
3
2000
Vicenta,5
2
1996
COLANSE PIEDRA
Berto
48
Celso
46
Erdul,4
4
Jojo
41
Monch
37
Pepe
35
Gil
32
Samuel
29
Evelyn,49
Erlyn, 23 Mayet, 22 Nina,19
I
II
III
cancer
allergy
cardiac pathology
asthma
Colanse-Piedra FamilyColanse-Piedra Family
June 28,2008June 28,2008
↑
Cris, 25 Bert,20 Don, 27

 STEP 2STEP 2
UNDERSTANDINGUNDERSTANDING
NORMAL FAMILYNORMAL FAMILY
FUNCTIONFUNCTION

Basic Family FunctionsBasic Family Functions
Provide support to each otherProvide support to each other
Establish autonomy & independence for eachEstablish autonomy & independence for each
personperson
Create rules governing conduct of family & ofCreate rules governing conduct of family & of
individuals within the familyindividuals within the family
Adapt to change in environmentAdapt to change in environment
Communicate with each otherCommunicate with each other

 STEP 3STEP 3
LEARNLEARN TO ASSESSTO ASSESS FAMILYFAMILY
STRUCSTRUCTURE ANDTURE AND
FUFUNCTIONNCTION ININ CLINICALCLINICAL
PRACPRACTICETICE

FAMILY ASSESSMENTFAMILY ASSESSMENT
INSTRUMENTSINSTRUMENTS
1.1. Family GenogramFamily Genogram
2.2. Family CircleFamily Circle
3.3. Family MapFamily Map
4.4. Family APGAR by SmilksteinFamily APGAR by Smilkstein
5.5. Clinical Biography and Life EventsClinical Biography and Life Events
6.6. SCREEMSCREEM

Family Circle
A graphic method
for disclosing dynamics
of family interaction
using circles.

FAMILY CIRCLEFAMILY CIRCLE
M OMMY
PAPA
MELVIN
NINA
BATZ
NANANG
JULIUS
MAYET

Taken from the “Daffodil” case presentation

FAMILY MAPFAMILY MAP
 Developed by Salvador MinuchinDeveloped by Salvador Minuchin
(Psychiatrist-Family therapist)(Psychiatrist-Family therapist)
 Facilitates communication of informationFacilitates communication of information
about a family system to colleagues soabout a family system to colleagues so
that they can be understoodthat they can be understood

functional relationshipfunctional relationship
dysfunctiondysfunction
over-involved relationship with plenty ofover-involved relationship with plenty of
intrusionintrusion
rigid boundary where rules are clear but non-negotiablerigid boundary where rules are clear but non-negotiable
clear boundary but negotiableclear boundary but negotiable
boundary that is diffuse or unclearboundary that is diffuse or unclear
presence of coalition or alliance between these peoplepresence of coalition or alliance between these people
escape from the systemescape from the system
third person is triangulated by conflict between thethird person is triangulated by conflict between the
other 2other 2

FAMILY APGARFAMILY APGAR
 Rapid screening test instrument for familyRapid screening test instrument for family
dysfunctiondysfunction
 Has adequate reliability and validity toHas adequate reliability and validity to
measure individual’s level of satisfactionmeasure individual’s level of satisfaction
about family relationshipsabout family relationships

FAMILY APGARFAMILY APGAR
 AA ADAPTATIONADAPTATION
 PP PARTNERSHIPPARTNERSHIP
 GG GROWTHGROWTH
 AA AFFECTIONAFFECTION
 RR RESOLVERESOLVE

 ADAPTATIONADAPTATION
 Capability of family to utilize & share inherent resourcesCapability of family to utilize & share inherent resources
(intra/extra-familial)(intra/extra-familial)
 PARTNERSHIPPARTNERSHIP
 Sharing of decision-making; measures satisfaction attained inSharing of decision-making; measures satisfaction attained in
solving problems by communicatingsolving problems by communicating
 GROWTHGROWTH
 Physical & emotional growth; measures satisfaction ofPhysical & emotional growth; measures satisfaction of
available freedom to changeavailable freedom to change
 AFFECTIONAFFECTION
 How love, anger, hatred are shared between members;How love, anger, hatred are shared between members;
measures members’ satisfaction with intimacy & emotionalmeasures members’ satisfaction with intimacy & emotional
interaction existing in the familyinteraction existing in the family
 RESOLVERESOLVE
 How time, money, space are shared; measures membersHow time, money, space are shared; measures members
satisfaction with commitment by other members of familysatisfaction with commitment by other members of family

When is Family APGARWhen is Family APGAR
needed?needed?
1.1. When family is directly involved in caringWhen family is directly involved in caring
for the patientfor the patient
2.2. When treating a new patient in order toWhen treating a new patient in order to
serve as general view of family functionserve as general view of family function
3.3. When treating a patient whose family isWhen treating a patient whose family is
in crisisin crisis
4.4. When patient’s behavior makes youWhen patient’s behavior makes you
suspect a psychosocial problem possiblesuspect a psychosocial problem possible
due to family dysfunctiondue to family dysfunction

ALMOSTALMOST
ALWAYSALWAYS
Score = 2Score = 2
SOME OFSOME OF
THE TIMETHE TIME
Score = 1Score = 1
HARDLYHARDLY
EVEREVER
Score = 0Score = 0
AA I amsatisfied that I can turnI amsatisfied that I can turn
my family forhelp whenmy family forhelp when
something is troubling mesomething is troubling me
PP I amsatisfied with the wayI amsatisfied with the way
my family talks on things withmy family talks on things with
me & shares problems withme & shares problems with
meme
GG I amsatisfied that my familyI amsatisfied that my family
accepts & supports my wishesaccepts & supports my wishes
to take on new activities orto take on new activities or
directiondirection
AA I amsatisfied with the wayI amsatisfied with the way
my family expresses affectionmy family expresses affection
& responds to my emotion& responds to my emotion
such as anger, sorrow & lovesuch as anger, sorrow & love
RR I amsatisfied with the wayI amsatisfied with the way
my family and I share timemy family and I share time
togethertogether
Parameters

 SCORING:SCORING:
8 – 108 – 10 HIGHLY FUNCTIONALHIGHLY FUNCTIONAL
4 – 74 – 7MODERATELY DYSFUNCTIONALMODERATELY DYSFUNCTIONAL
0 – 30 – 3 SEVERELY DYSFUNCTIONALSEVERELY DYSFUNCTIONAL

CLINICALCLINICAL BIOGRAPHY &BIOGRAPHY & LLIFEIFE
EVENTSEVENTS
 Valuable tools which can facilitate analysisValuable tools which can facilitate analysis
of connectionof connection
 Individual’s experiences with health andIndividual’s experiences with health and
sickness are connected with his personalsickness are connected with his personal
lifelife

Example (taken from “Daffodil” case presentation)Example (taken from “Daffodil” case presentation)
1982 - Childhood years1982 - Childhood years
1983 - Sibling Rivalry1983 - Sibling Rivalry
1990 - “ First love”1990 - “ First love”
- Financial Difficulties- Financial Difficulties
1992 - Sexually Violated1992 - Sexually Violated
19971997 - Met Bobby- Met Bobby Common-law relationshipCommon-law relationship
1999 - 21999 - 2ndnd
pregnancypregnancy
2000 - 32000 - 3rdrd
pregnancypregnancy
- Resignation of Bobby- Resignation of Bobby
2001 - “Guest Relations Officer”2001 - “Guest Relations Officer”
2002 - “New boyfriend”2002 - “New boyfriend”  44thth
pregnancypregnancy
2004 - 52004 - 5thth
pregnancypregnancy
- Reconciliation with Bobby- Reconciliation with Bobby
2005 - Financial problems2005 - Financial problems
2006 - Vaginal bleeding2006 - Vaginal bleeding
- Hospitalized- Hospitalized  Cervical CancerCervical Cancer

SCREEMSCREEM
 Important as to assess family’sImportant as to assess family’s
capacity to participate incapacity to participate in
provision of health care and itsprovision of health care and its
capacity to cope with crisiscapacity to cope with crisis

SCREEMSCREEM
RESOURCERESOURCE
SSOCIALOCIAL
Social interaction is evident among family members. FamilySocial interaction is evident among family members. Family
members have well-balanced lines of communication with extra-members have well-balanced lines of communication with extra-
familial social groups.familial social groups.
CCULTURALULTURAL
Cultural pride orsatisfaction can be identified, especially inCultural pride orsatisfaction can be identified, especially in
distinct ethnic groups.distinct ethnic groups.
RRELIGIOUSELIGIOUS
Religion offers satisfying spiritual experiences as well as contactsReligion offers satisfying spiritual experiences as well as contacts
with an extra-familial support group.with an extra-familial support group.
EECONOMICCONOMIC
Economic stability is sufficient to provide both reasonableEconomic stability is sufficient to provide both reasonable
satisfaction with financial status and an ability to meet economicsatisfaction with financial status and an ability to meet economic
demands of normative life events.demands of normative life events.
EEDUCATIONADUCATIONA
LL
Education of family members is adequate to allow members toEducation of family members is adequate to allow members to
solve orcomprehend most of the problems that arise within thesolve orcomprehend most of the problems that arise within the
format of the life style established by the familyformat of the life style established by the family
MMEDICALEDICAL
Health care is available through channels that are easily establishedHealth care is available through channels that are easily established
and have previously been experienced in a satisfactory mannerand have previously been experienced in a satisfactory manner

33010802 tools-for-family-assessment

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