Family

Assessment
Tools
Tim FOME
Fakultas Kedokteran Universitas Andalas

With Courtesy to
Prof. Zorayda E. Leopando 1/9
 Diagnostic tools
Individual Patients
Newborn APGAR
Newborn screening
Child Growth and Development Chart
Pregnant Mother Prenatal check up
Fundus height
Doppler
Laboratory exams
 Diagnostic tools
Families Function
Relationship
Structure
Community Health indicators
Rates and ratios
Epidemiologic investigation
 Family Oriented Primary Care
• Learning to “think family”
• The importance of genogram
• The family within a larger system – use an eco-
map
• Chronic illness and disability – supporting family
caregivers
• Working with family members – the family
conference
• Identifying the family at risk
 FAMILY ASSESSMENT
• is the process of collecting data about the
family structure, and the relationships and
interactions among individual members.
• It is a continuous process.
• It’s aim is to generate diagnoses with
goals and interventions for care created in
collaboration with the family and
caregivers.
 Tools for Family Assessment
1. Genogram
2. Family Apgar
3. Eco-map
4. SCREEM
5. Family Lifeline
6. Family Circle
 1. Family Genogram
• A graphic representation of a family tree
that displays detailed data about the
relationships among individuals in a family
over a period of time, usually three
generations.

• Allows the user to analyze hereditary

patterns and psychological factors that
punctuate these relationships
 Components of Family
Genogram:
Family Tree Family names; three generations; names and
age of all members; significant dates;

Family background on Illnesses; causes of deaths

health
Social and interactional Members living together; possible source of
influences stress; relationship
 The first born of each generation is farthest to
the left with the following siblings going to the
right according to order of birth
 Family name is placed above each major family
unit
 Names and ages written below the symbol
 Index patient is identified with an arrow
 Date must be indicated when it was made to be
able to adjust the ages over time
Genogram
Veridiano Family
as of April 11, 2010
Project 4, Quezon City

1943 1947

Constantino, 64, 2006 ■ Mila Fatima 47 1994 ∆

1967 1964 1968 1970 1965 1982

2007

Thess 42 ♥ Nel 45 May 39 ♦ Jojo 44 ♥ 1973 1971 Peng 27 ♥

∆ Ruptured aneurysm
■ Heart failure Chok 36 ♦ 2005 Tere 38
♥ Hypertension
♦ Bronchial Asthma
Ja 4 ♦
 Family Genogram: Uses
• Quick overview on the family members
and relationship
• A way to visually overlay biomedical and
psychological information
• A study tool for gaining a comprehensive
understanding of multigenerational family
systems
 2. Family APGAR
• This is a 5-question assessment tool used
for rapid assessment of family function
and dysfunction.
• It measures an individual’s level of
satisfaction about family relationships.
 Family APGAR
• Adaptation- the ability of a family to use and share
inherent resources which can be either intra- or
extra-familial
• Partnership- the sharing of decision making which
measures the satisfaction of solving problems through
communicating
• Growth- pertains to both physical and emotional
aspects and measures the satisfaction of the freedom
to change
• Affection- emotions that are shared with and between
family members which measures the satisfaction with
the intimacy and emotional interaction that exist in the
family
• Resolve- refers to how time, money, and space are
shared; this measures the satisfaction with the
commitment made by members of the family
 Family APGAR
There are 4 basic situations wherein the Family
APGAR is needed:

• When the family is directly involved in caring for

the patient.
• When treating a new patient in order to get
information to serve as general view of family
function
• When treating a patient whose family is in crisis.
• When a patient’s behavior makes you suspect a
psychosocial problem possibly due to family
dysfunction.
 FAMILY APGAR
QUESTIONNAIRE PART I
• Helps define the degree of the patient’s
satisfaction or dissatisfaction with family
function
 Part I
Almost Some of Hardly
always the time ever
(2) (1) (0)

I am satisfied that I can turn to my family

A for help when something is troubling me.

I am satisfied with the way my family talks

P about things with me and shares problems
with me.
I am satisfied that my family accepts and
G supports my wishes to take on new
activities or directions.
I am satisfied with the way my family
A expresses affection and responds to my
emotions such as anger, sorrow, and love.
I am satisfied with the way my family and I
R share time together.
 Family APGAR
• Scoring:
– 8-10 points = highly functional family
– 4-7 points = moderately dysfunctional family
– 0-3 points = severely dysfunctional family
 Family APGAR Part II
• Delineates relationships with other
members,
• identifies persons who can give
assistance to the patient,
• and indicates conflicts not revealed in part
I
 Part II
• Who lives in your home?

Nam Relations Ag Sex

e hip e

How do you get along?

Well Fairly Poor

 Part II
• If you don’t live with your Name Relations Se
family, list down the persons hip Age x
you turn to for help

Well Fairly Poor

• How do you get along?
 3. Ecomap = Family Mapping
• The family within a larger system
• Reflects relationships and interaction
• Provides schematic description whom to
ask for assistance in making decision for
patients
• Identify possible source of somatic
complaints
 Family Mapping
• A double line between two people
indicates a functional relationship
• A single line with a break in the middle
indicates dysfunction
• Three parallel lines between two people
denotes an over-involved relationship
where there is plenty of intrusion.
• A solid line perpendicular to the
relationship line symbolizes a rigid
boundary where the rules are but non-
negotiable
• A broken line perpendicular to the
relationship lines symbolizes a boundary
that is clear but negotiable
• A dotted line perpendicular to the
relationship line signifies a boundary that
is diffuse or unclear.
• A bracket encompassing several people
signifies the presence of a coalition or
alliance between these people

[ ]
• An arrow pointing away from the system
signifies escape from the system
• An open ended arrow with its open end
embracing two individuals and the pointed
end pointing to a third signifies that the
third person is being triangulated by the
conflict between the other two
Ecomap
Ecomap
Ecomap
Ecomap
Ecomap
 4. SCREEM
• An important tool to assess a family’s
capacity to participate in the provision of
health care or to cope with crisis.
• It makes use of 6 factors which can be
considered as resource or as pathology.
 SCREEM
Resource Pathology

Social -Isolated from extra-familial

-social interaction is evident among -Problem of over commitment
family members
-Family members have well-balanced
lines of communication with extra-
familial social groups
Cultural - Ethnic and cultural inferiority
-cultural pride and satisfaction can
be identified

Religious - Rigid dogma/rituals

- Offers satisfying spiritual
experiences as well as contacts with
an extra-familial support group
 SCREEM
Economic -Economic deficiency
- Economic stability is sufficient to -Inappropriate economic plan
provide both reasonable satisfaction
with financial status and an ability to
meet economic demands of normative
life events
Educational -handicapped to comprehend
- Education of members is adequate to
allow members to solve or comprehend
most problems that arise within the
format of the lifestyle established by the
family
Medical - Not utilizing health care
- Medical health care is available facilities/resources
through channels that are easily
established and have previously been
experienced in a satisfactory manner
 5. Family Lifeline (Clinical
Biographies / Life Chart )
• Clinical biographies and life charts make
valuable tools because it has the capacity
to put side by side significant life and
clinical events with their dates of
occurrences and make a connection
between these facts.
 6. Family Circle
• Family circles are often used on individuals and in some
small groups.
• Instructions are given to the patient to look at the circle
as if it is his family and then draw small circles to
represent the patient and those people who are
important to him.
– Physicians draw a big circle
– Ask patient to draw smaller circles within the big circle
or outside. Each circle represent significant people in
his/her life. Distance and size vary according to
degree of closeness and significance to the patient
• Difficulty of interpretation and standardization poses as a
disadvantage.
 Family Circle
Dex

Mama Mama
Pesh chuchi

Arra
Rihan
ne
Me
Ja Kuya
Nel
Chok

Erin Ate
Tere
THANK YOU