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Tools for assessing families in primary care
- 1. Family Systems Concepts: Tools for Assessing Families in Primary Care NUNANONG RODCHEUY 13 JUN 2016
- 3. Introduction – Each person lives among an exciting cast of characters who inspire them, support them, and also criticize and fight with them – To know a person is to know the people in their lives
- 5. The Genogram (Family Anatomy) – Essential tool to recall information about family member’s names, relationships, and overall structure – Can be updated at subsequent visits – Biomedical focus : family medical and genetic information – Biopsychosocial focus
- 6. The Genogram (Family Anatomy) Information – Names – Ages – Marital status – Former marriages – Children – Households – Significant illnesses – Dates of such traumatic events as deaths – Occupations – Emotional closeness – Distance, or conflict between members
- 7. The Genogram (Family Anatomy) Information – Transgenerational family patterns of loss – Dysfunctional emotional patterns – Common medical problems
- 11. The Family Life Cycle – Developed by family sociologists Hill and Duvall (8 stages) – A template to quickly assess a patient and family’s developmental concerns – No single “normal” family life cycle
- 12. Married Couples Childbearing Family Families with Preschool Children Families with School-aged Children Families with Adolescence Families Launching Young Adults Middle-aged Parents Families In Later Years
- 13. Duvall’s Developmental Stages Married Couples – Establish couple identity and a mutually satisfying marriage – Realign relationships with extended family to include spouse – Make decisions about parenthood
- 14. Duvall’s Developmental Stages Childbearing family – Integrate infant into family – Find mutually satisfying ways to deal with child care responsibilities – Expand relationships with extended family by adding parenting and grand parenting role
- 15. Duvall’s Developmental Stages Families with Preschool Children – Socialize the children – Integrate new children while still meeting needs of the other children – Maintain healthy relationships within the family and extended family
- 16. Duvall’s Developmental Stages Families with School-aged Children – Promote the school achievement and foster the healthy peer relations of children – Maintain a satisfying marital relationships – Meet the physical health needs of family members
- 17. Duvall’s Developmental Stages Families with Adolescence – Balance freedom with responsibility as teenagers mature and become more autonomous – Refocus on marital and career issues
- 18. Duvall’s Developmental Stages Families Launching Young Adults – Develop adult-adult relationships with grown children – Expand family circle to include new members acquired by the marriage of grown children – Assist aging and ill parents of husband and wife – Renew and renegotiate marital relationship
- 19. Duvall’s Developmental Stages Middle-aged Parents – Strengthen marital relationship – Provide health-promoting lifestyle – Sustain satisfying relationships with aging parents and children
- 20. Duvall’s Developmental Stages Families In Later Years – Maintain satisfying living arrangement – Adjust to reduced income – Maintain marital relationship – Continue to make sense of one’s existence – Maintain intergenerational family ties – Adjust to loss of spouse
- 21. Reference Duvall, E. M. & Miller, B. (1985). Marriage and family development. New York: Harper & Row.
- 22. The Family Life Cycle
- 26. The Family Life Cycle – The individual life cycles of each family member intertwines with the life cycles of other family members, represented by the Family Life Spiral – Shifting periods – Centripetal : indicating forces that pull the family together – Centrifugal : reflecting the forces that pull family members more apart from one another
- 28. Family Assessment – Family assessment is a continuous activity based on theoretical concepts and tools that easily can be integrated into daily practice
- 29. Family Assessment –Brief assessment tools – The Family APGAR – The Family Circle – PRACTICE
- 30. Family Assessment Family APGAR – Adaptation – Partnership – Growth – Affection – Resolve
- 34. Family Assessment Family PRACTICE – Presenting problem – Roles – Affect – Communication patterns – Time in family life cycle – Illness history – Coping with stress – Ecology and culture
- 35. Family Systems Concepts in Primary Care Family Structure Family Process Family Across Time Family Characte ristic
- 36. Family Characteristics –The Family as a System –Family Stability –Family Transition –Family World View –Relational Context of the Symptom
- 37. Family Characteristics The Family as a System – The family system is more than just the sum of its individual members – Family groups have unique characteristics – Organized by interpersonal structures and processes – Enable to be both stable and adaptable over time
- 38. Family Characteristics Family Stability – Interpersonal process by which the family strives to maintain emotional balance in the system
- 39. Family Characteristics Family Transition – Interpersonal process by which the family adapts to developmental growth in members, and varying expectations and roles in the community
- 40. Family Characteristics Family World View – Families have general views of themselves as either competent or ineffective, cohesive or fragmented – Based on culture, previous history, and individual perspectives
- 41. Family Characteristics Relational Context of the Symptom – The presenting symptom is part of a large family and psychosocial context that can influence and be influenced by that symptom
- 42. The Purcell Family Bob Mrs. Purcell Mr. Purcell Mary
- 44. The Purcell Family Characteristics Relational context of the symptom Mr. Purcell’s more frequent chest pains Family stability Family transition Mrs. Purcell’s new job Bob’s upcoming graduation Mary’s engagement Family world view Family as a system How the family’s functioning as a whole might play a part in Mr. Purcell’s symptoms and their alleviation
- 45. Family Systems Concepts in Primary Care Family Structure Family Process Family Across Time Family Characte ristic
- 46. Family Structure –Hierarchy –Boundaries –Family Role Selection –Alliance –Coalition
- 47. Family Structure Hierarchy – How power or authority is distributed within the family – General cultural consensus places parents above children in the family hierarchy – A parentified child, often the oldest, performs parental functions when one or both parents have abdicated the role
- 48. Family Structure Boundaries – Different functional subgroups in the family – In respectful interactions, families recognize the boundaries around subgroups
- 49. Family Structure Family Role Selection – The conscious or unconscious assignment of complementary roles to members of a family – During health crises, family members seem to adopt identifiable roles – Caretaker – The one who “can’t handle bad news”
- 50. Family Structure Family Role Selection – The scapegoat or noble symptom bearer, who is – Identified by the family as the source of problems – Accepts the family’s blame – Distracts from other individual or family problems – Reflects the dysfunction of the family as a whole
- 51. Family Structure Alliance – A positive relationship between any two members of a system
- 52. Family Structure Coalition – A relationship between at least three people in which two collude against a third
- 53. The Purcell Family Bob Mrs. Purcell Mr. Purcell Mary
- 55. The Purcell Family Structure hierarchy Parentified child Mary coalition Mary & Mr. Purcell >> Mrs. Purcell Bob & Mrs. Purcell >> Mary Alliance Generational boundaries Mary & Mr. Purcell Bob & Mrs. Purcell Family role selection Mr. Purcell : Sick member, Scape goat Mrs. Purcell : Uncaring spouse Mary : Family health expert Bob : Mrs. Purcell’s defender
- 56. Family Systems Concepts in Primary Care Family Structure Family Process Family Across Time Family Characte ristic
- 58. Family Process Enmeshment – A system in which members have – Few interpersonal boundaries – Limited individual autonomy – High degree of emotional reactivity – At later stages of the life cycle, enmeshment can inhibit individual development and growth
- 59. Family Process Disengagement – Characterizes a family system in which members are – Emotionally distant – Unresponsive to each other
- 60. Family Process Triangulation – Occurs when a third person is drawn into a two-person system in order to diffuse anxiety or intimacy conflicts in the two- person system – This process differs from family coalitions
- 61. Family Process Family Patterns – The ordered sequences of interaction that typify how a family functions, particularly when under stress
- 62. The Purcell Family Bob Mrs. Purcell Mr. Purcell Mary
- 63. The Purcell Family Process Enmeshment Mary & Mr. Purcell Disengagement Mrs. Purcell – Mary Mrs. Purcell – Mr. Purcell Triangulation Mr. Purcell – Mary – Mrs. Purcell Family pattern The focus of attention shifted to health issues or a third family member when family members became upset with each other
- 64. Family Systems Concepts in Primary Care Family Structure Family Process Family Across Time Family Characte ristic
- 65. The Family Across Time –Family Developmental Stage –Family Projection Process –Intergenerational Coalition
- 66. The Family Across Time Family Developmental Stage – Based on the family life cycle, family processes and interactions are varies – Identifying the life cycle stage helps clinicians to tailor their family-oriented questions
- 67. The Family Across Time Family Projection Process – The transmission of unresolved conflicts, issues, roles, and tasks from one generation to another
- 68. The Family Across Time Intergenerational Coalition – Two members from different generations against a third member of the family
- 69. The Purcell Family Bob Mrs. Purcell Mr. Purcell Mary
- 70. The Purcell The family across time Family Developmental Stage Launching children Family Projection Process Mr. Purcell’s unresolved grief over his mother’s death Intergenerational Coalition Mrs. Purcell’s lack of attachment to her mother- in-law
- 71. THANK YOU
Notes de l'éditeur
- When illness occurs during a centripetal period, like infancy, the family may be more easily mobilized to care for the ill member than it is during a centrifugal period like adolescence
- The family’s sense of efficacy can be enhanced when they feel that they have coped with a crisis well, or when the healthcare provider recognizes their efforts and affirms their strengths
- parents to have a private relationship that is not undermined by children or grandparents
- Families with adolescents may appear to be more disengaged than families with young children, and still be caring well for one another
- the men in each generation never go to physicians for health problems