FAMILY ASSESSMENT TOOLS LEARNING OBJECTIVES Describe the advantages for assessing family (C2) Define the family genogram, family map, family APGAR and its function (C2) assess family functioning assess family dynamic assess coping mechanisms of the family (c2) assess family structure to have a picture of the multigenerational patterns of behavior or illnesses.
FAMILY ASSESSMENT TOOLS LEARNING OBJECTIVES Describe the advantages for assessing family (C2) Define the family genogram, family map, family APGAR and its function (C2) assess family functioning assess family dynamic assess coping mechanisms of the family (c2) assess family structure to have a picture of the multigenerational patterns of behavior or illnesses.
FAMILY ASSESSMENT TOOLS LEARNING OBJECTIVES Describe the advantages for assessing family (C2) Define the family genogram, family map, family APGAR and its function (C2) assess family functioning assess family dynamic assess coping mechanisms of the family (c2) assess family structure to have a picture of the multigenerational patterns of behavior or illnesses.
FAMILY ASSESSMENT TOOLS LEARNING OBJECTIVES Describe the advantages for assessing family (C2) Define the family genogram, family map, family APGAR and its function (C2)
Why do we Need tools to Assess the family?
assess family functioning assess family dynamic assess coping mechanisms of the family assess resources assess family structure
to have a picture of the multigenerational patterns of behavior or illnesses. to assess the normal crisis or common illness to be encountered in each stage of development. to provide anticipatory care and guidance.
Why do we Need tools to Assess the family?
An understanding of the family in terms of the struggles to be functional will enable FP to make correct diagnosis and intervention
FAMILY DYNAMICS An interactions and relationships among the individual members of a family Reflects and influence the physical, mental and spiritual health of the individuals in a family. FAMILY DYNAMICS An understanding of the dynamics helps the attending family physician to diagnose the disease and dis-ease in the patient sitting in his consultation room and to recognize the factors that may help or retard the recovery of this patient.
FAMILY ASSESSMENT TOOLS Anatomy Genogram Development Family life cycle Function APGAR Family Map Lifeline SCREEM Impact BATHE GENOGRAM Is a biopsychosocial family tree. It records the family in its life cycle, family illnesses and relationship A genogram is a versatile clinical tool that can help FP integrate a patients family information into the medical problem-solving process for better patient care A genogram supplements the problem list giving FP an overview of the main problems affecting the family over 3 or more generations A genogram can be drawn in skeletal form during one of the first few visits, ideally the first visit and then it can elaborated during subsequent visits as more is known about the family GENOGRAM COMPONENTS Symbols Standardized Symbols used in Family Genograms A b m d D male female Sex not specified Deceased/death Adopted female date of birth date of marriage date of divorce Date of death abortion or miscarriage Pregnancy-child in utero Dizygotic twins Monozygotic Twins Induced abortion STANDARDIZED SYMBOLS USED IN FAMILY GENOGRAMS Symbols of diseases or situation Allergy Alcoholism Obesity Asthma Hypertension xxx xxx
Heart disease Stroke Depression War Casualty COMMONLY USED ABBREVIATIONS ALC Alcoholic ALL Allergy ARTH Arthritis CAD Coronary Artery Disease CVA Cerebrovascular Accident CA Cancer DEP Depression DM Diabetes mellitus GI GI tract disease HT Hypertension MI Myocard Infarction MVP Mitral Valve Prolapse PUD Peptic Ulcer Disease SLE Systemic Lupus Erythematosis TB Tuberculosis STANDARDIZED SYMBOLS USED IN FAMILY GENOGRAMS married and year Divorce and year Unmarried relationship Separation and year 1989 1990 1992 Conflictual relationship Distance relationship Close relationship 1989 1989 1992 Family living together
I II III Bakri, as of 8 April 2010 Ardi,68 Nia,64 1970 1969
1. Symbols 2. Three or more generations 3. The name of family 4. A listing of the first born of each family to the left, with siblings listed sequentially to the right 5. The names of all family member 6. Age or year of birth of all family members 7. Any deaths, incl. age of death and cause 8. Dates of marriages and divorces 9. Significant diseases or problems of family members 10. Indication of members living together in the same household 11. A key depicting all symbols used 12. Symbols selected for simplicity and maximum visibility
FAMILY INFORMATION IS USED IN 3 TYPE SITUATIONS:
1. Evaluating somatic complaint by testing biopsychosocial hypotheses 2. Assessing a patients risk for biomedical and mental disorders 3. Planning management by considering how family factors may facilitate or complicate it USES OF THE GENOGRAM (CROUCH AND DAVIS, 1987) Allowing the family physician and other health professional to review quickly the family situation Building rapport by using the first names of family members, knowing who is living in the home Identifying at a glance significant risk factors : Hypertension, DM, Ca, Obesity etc Recognizing the need for screening in patients who at high risk Promoting lifestyle changes and health education (healthy living) Demonstrating that family relationship are a concern of the family physician and important to the health of each family member This is a self-drawing by an 8 year old girl who participated in a support group for children affected by domestic violence sponsored by Cedar Valley Friends of the Family.
One cannot escape sensing this child's unhappiness; the frown she drew on her little face clearly sets the mood. However, the up-side- down rainbow is perhaps the most significant message... Generally, we think of rainbows as a happy reminder of hope for the future. In this simple drawing, the little girl innocently, but quite vividly
Relationship of the members 43 84 Sugeng Ani
myoma 60 Utomo 58 Sri DM CA Colon/Renal 54 Arti FAM 84 1959 Putro 48 44 44 Tyio Tuti Nina Lung Ca 46 Sam Aria Imam 20 16 AMI Genogram : 24 January 2008 FAMILY MAP APGAR This is a five-item questionnaire designed to elicit the patients perception of the current state of his family relationships, and serves as a rapid screening instrument for family dysfunction. APGAR Adaptation is the capability of the family to utilize and share inherent resources Partnership is sharing of decision making. This measures the satisfaction attained in solving problems by communicating. Growth refers to both and emotional growth. This measures the satisfaction of the availability freedom of change APGAR Affection is how emotions like love, anger and hatred are shared between members. This measures the members satisfaction with intimacy and emotional interaction that exist in the family. Resolve refers to how time, space and money are shared. This measures the members satisfaction with the commitment made by other members of the family.
8-10 point (Highly functional family) 4-7 point (Moderately dysfunctional family) 0-3 point (Severely dysfunctional family)
BATHE TECHNIQUES (Stuart and Liebermans) 15 minutes method of primary care counseling It helps draw out the quiet patient and provides a structure of when to move on in a talkative patient B = Background A = Affect T = Troubling H = Handling E = Empathy B = Background : assessing whats the background situation (areas of psychological problems) How are things at home? At work? Whats different in your life between now and before?
A = Affect = the patients affect (about common areas generating strong feelings) How do you feel about your home life? How do you feel about your work/school? T = Troubling: the problem that is most troubling for the patient What most worries you about your life? How stressed are you by this problem? What do you think this problem means to you?
H = Handling: the manner in which the patient has been handling the problem, problems are often mishandled life difficulties How are you handling the problems in your life? What have you tried to solve the difficulty? How much support are you getting at home/work? Who gives you support for dealing with problems?
E = Empathy : respons that conveys empathy,express understanding of the patients distress I can understand that you would feel angry That must have been difficult This is a tough situation to be in
Thank you 1. Rakel RE. The Family Genogram. In Rakel RE. Textbook of Family Practice. Sixth Edition. WB Saunders Co. Philadelphia. 2002. pp 19 30.
2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, 2004. section 3 chapter 3 pp 58- 62