JONATHAN C.
PACUNAYEN, RMT, MD
Department of Family and Community Medicine
Family-Oriented and Community-Oriented Care
Family Medicine: is a specialty of medicine
concerned with providing comprehensive care
to individuals and families
Community Medicine: is a specialty of medicine
concerned with the health of a specific
population or group
COPC: is a systematic approach to improving
primary health care services through integrating
clinical science with public health at the
community level.
COPC Approach:
a. Defining a community by geographical,
demographic, or other characteristics
b. Determining the health needs of the
community in a systematic manner
c. Identifying and prioritizing health
problems
d. Assessing outcomes
FOPC: involves the patient’s family or
household as an integral part of information-
gathering, clinical reasoning, and patient care.
Family Structure:
A. Nuclear or small families: consisting
either a married couple (or a divorced
or widowed parent) with unmarried
children or of a married couple without
children
B. Extended families: pertain to a number
of nuclear families linked together by
virtue of the kinship bond between
parents and children or between
siblings. In this set-up, families of
orientation are merged with families of
procreation
C. Lineal families: consisting of two or
more generations with each generation
composed of one married couple (or a
divorced person, widow, or widower)
D. Joint families: consisting of two or
more married couples (or divorced
persons, widows, or widowers) of the
same generation
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E. Blended families: in which one or both
of the parents have had a previous
marriage, and possibly children from
that marriage
Other authors include:
A. Adoptive family: where the child is not
related by blood to the parent, but has
been adopted legally
B. Foster family: where one or more of
the children are not the natural children
of the parents. The child may stay with
the family for an extended period
through special government agencies
C. Communal family: are groups of people
who live together and share properties,
which are formed by specific religious
beliefs, some having the same
illness/condition; while others are
formed from economic necessity
Other types:
a. Single parent
b. Cohabiting couples
c. Families consisting of relatives and/or
friends
d. Gay marriages
Attributes of a well-functioning family:
I. Role distinction in a well-
functioning family are clear and
there is a distinct boundary
between the integral family
members and those in the
extended family
II. Individuality and a high degree of
differentiation are encouraged in a
successful family
III. Rules are clear and reasonable.
They change as the children mature
IV. Good communication is essential.
All family members speak for
themselves; children are listened to
and their input are respected
V. Authority or power is clearly vested
in individuals, with the tacit
agreement of all family members.
As the family moves through
JONATHAN C. PACUNAYEN, RMT, MD
Department of Family and Community Medicine

different stages in its life cycle and

the children mature, there will be
shifts in the family’s power base
VI. A full range of emotions is
acceptable, appropriate and
encouraged.
VII. Conflicts are resolved through
bargaining and negotiation, with all
family members able to participate
VIII. Task or chores are shared by family
members, with a clear
understanding of who performs
which tasks. Individuals can follow
through in their own style and time
IX. Individual differences in energy
levels, perception of time, and
space requirements are respected
X. High esteem, both for the individual
and the family, develops naturally.
The well-functioning family is not
necessarily quiet, well-ordered, and
rational all the time.

***Family-level affects can either be beneficial

or harmful to the health of an individual. Which
of the following choices is an attribute of a well-
functioning family?
A. Role distinctions are clear and there are
rigid boundaries between integral
members and those in the extended
family
B. Individuality and a high degree of
differentiation is encouraged in a
successful family
C. Rules are clear and reasonable and
maintained in all stages of the life cycle
D. Authority is vested on select
individual/s with implied agreement
from all members throughout the
different life cycle stages
E. Expressing a full range of emotions
should only be done when it is
considered appropriate by the
authoritative figure.

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JONATHAN C. PACUNAYEN, RMT, MD
Department of Family and Community Medicine
Family Life Cycle:
I. Unattached young adult
a. EPOT: Accepting financial and
emotional responsibility for
oneself
b. Differentiation of the self in
relation to the family of origin
c. Development of intimate peer
relationships
d. Establishment of the self in
relation to work and financial
independence
II. Newly-married couple
a. EPOT: Commitment to the new
system
b. Formation of the marital system
c. Realignment of relationships
with extended families and
friends to include the spouse
III. Family with young children
a. EPOT: Accepting new members
in the system
b. Adjusting the marital system to
make space for children
c. Joining in child-rearing and
financial and household tasks
d. Realignment of relationships
with the extended family to
include parenting and
grandparenting roles
IV. Family with adolescents
a. EPOT: Increasing flexibility of
family boundaries to include
children’s independence and
grandparents’ frailties
b. Shifting of parent-child
relationships to permit
adolescents to move in and out
of the system
c. Focus on midlife marital and
career issues
V. Launching family
a. EPOT: Accepting a multitude of
exits from and entries into the
system
b. Beginning of shift toward joint
caring for the older generation
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c. Renegotiation of marital status
as a dyad
d. Development of adult-to-adult
relationships between grown-
up offspring and their parents
e. Realignment of relationships to
include in-laws and
grandchildren
f. Dealing with the disabilities and
death of grandparents
VI. Family in Later life
a. EPOT: Accepting the shifting of
generational roles
b. Maintaining own and/or couple
functioning and interests in the
face of physiological decline;
exploration of new familial and
social role options
c. Support for a more central role
of middle generation
d. Making room in the system for
the wisdom and experience of
the elderly and supporting the
older generation
e. Dealing with the loss of spouse,
siblings, and peers; preparation
for one’s own death
f. Life review and integration
***In this stage of the Family Life cycle, one of
the second order changes is the renegotiation
of the marital system with the partner?
A. Newly Married Couple
B. Family with Young children
C. Family with adolescents
D. Launching family
E. Family in Later Years
JONATHAN C. PACUNAYEN, RMT, MD
Department of Family and Community Medicine

LEVELS OF FAMILY INVOLVEMENT:

1. This model describes the levels of
involvement physicians can enter in delivering
health care efficiently.

2. These levels are dependent on how deep the

physicians want, as health care providers, to be
involved in their patient’s family.

3. In our country, it is best for any medical

practitioner to be at least at Level III.

A. Level I:
a. Minimal emphasis on the family
in the delivery of health care
b. Only for practical and medico-
legal reasons
c. Training in medical schools

B. Level II:
a. Ongoing medical information
and advice
b. Works collaboratively with
patients and families
c. Understands the triangular
nature of the patient-doctor-
family relationship

C. Level III:
a. Feelings and providing
emotional support
b. The physician understands
normal family development and
how families react to stress
c. Support, encouragement, and a
preliminary assessment of the
family’s functionality

D. Level IV:
a. Assessment of family
dysfunction
b. Provision of intervention

E. Level V:
a. Family Therapy

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