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Tools for Family

Assessment
Dr. Nur Afrainin Syah, M.Med.Ed, PhD
With Courtesy to
Prof. Zorayda E. Leopando

• How many of you are physicians of families with several
generations?
• How do you assess families in terms of health?
• What tools do you use?

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 .

• It’s aim is to generate diagnoses with goals and interventions for care created in collaboration with the family and caregivers. and the relationships and interactions among individual members. . • It is a continuous process.FAMILY ASSESSMENT • is the process of collecting data about the family structure.

4. 6. 5. 2. 3. Genogram Family Apgar Eco-map SCREEM Family Lifeline Family Circle .Tools for Family Assessment 1.

usually three generations. 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.1. • Allows the user to analyze hereditary patterns and psychological factors that punctuate these relationships .

causes of deaths Social and interactional influences Members living together. Family background on health Illnesses. relationship . significant dates. three generations. possible source of stress. names and age of all members.Components of Family Genogram: Family Tree Family names.

 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 .

2010 Project 4. Quezon City 1943 1947 Constantino.Veridiano Family as of April 11. 64 2006 ■ 1967 1964 1968 1970 Mila Fatima 47 1994 ∆ 1965 1982 2007 Thess 42 ♥ Nel 45 ∆ Ruptured aneurysm ■ Heart failure ♥ Hypertension ♦ Bronchial Asthma May 39 ♦ Jojo 44 ♥ 1973 Chok 36 ♦ 1971 2005 Ja 4 ♦ Tere 38 Peng 27 ♥ .

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 .

• It measures an individual’s level of satisfaction about family relationships. Family APGAR • This is a 5-question assessment tool used for rapid assessment of family function and dysfunction.2. .

pertains to both physical and emotional aspects and measures the satisfaction of the freedom to change • Affection.the sharing of decision making which measures the satisfaction of solving problems through communicating • Growth. money.Family APGAR • Adaptation. this measures the satisfaction with the commitment made by members of the family .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. and space are shared.refers to how time.or extrafamilial • Partnership.the ability of a family to use and share inherent resources which can be either intra.

. • 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.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 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 .

P I am satisfied with the way my family talks about things with me and shares problems with me. A I am satisfied with the way my family expresses affection and responds to my emotions such as anger. and love. R I am satisfied with the way my family and I share time together. sorrow.Part I Almost always (2) A I am satisfied that I can turn to my family for help when something is troubling me. Some of the time (1) Hardly ever (0) . G I am satisfied that my family accepts and supports my wishes to take on new activities or directions.

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. and indicates conflicts not revealed in part I . identifies persons who can give assistance to the patient.

Part II • Who lives in your home? Name Relationship Age How do you get along? Well Fairly Poor Sex .

list down the persons you turn to for help Name • How do you get along? Well Relationship Fairly Age Poor Sex .Part II • If you don’t live with your family.

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 .

. It makes use of 6 factors which can be considered as resource or as pathology.4. SCREEM • An important tool to assess a family’s capacity to participate in the provision of health care or to cope with crisis.

SCREEM Resource Pathology Social -Isolated from extra-familial -Problem of over commitment -social interaction is evident among family members -Family members have well-balanced lines of communication with extra-familial social groups Cultural .Offers satisfying spiritual experiences as well as contacts with an extra-familial support group .Ethnic and cultural inferiority -cultural pride and satisfaction can be identified Religious .Rigid dogma/rituals .

Not utilizing health care facilities/resources .Economic stability is sufficient to provide both reasonable satisfaction with financial status and an ability to meet economic demands of normative life events -Economic deficiency -Inappropriate economic plan Educational .SCREEM Economic .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 -handicapped to comprehend Medical .Medical health care is available through channels that are easily established and have previously been experienced in a satisfactory manner .

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. .5.

Family Circle • Family circles are often used on individuals and in some small groups.6. • Physicians draw a big circle • Ask patient to draw smaller circles within the big circle or outside. . • 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. Distance and size vary according to degree of closeness and significance to the patient • Difficulty of interpretation and standardization poses as a disadvantage. Each circle represent significant people in his/her life.

Family Circle Dex Mama Pesh Mama chuchi Arra Rihanne Me Ja Kuya Nel Chok Erin Ate Tere .

assess each other • Reflect on the experience by answering the following questions • What did you feel? • Were you able to finish? Why yes and why not?? • How will you teach the tools to your medical students?? .Actual Exercise Using the Tools • Work in pairs.