Tools in Family Assessment

JI Veridiano,Ofelia S.

Introduction
Every patient is a member of a family
A physician must always keep in mind that
the way a patient reacts to an illness will
depend a lot on his family
It will depend on the family physician as to
up to what level he will involve a patients
family to evaluate his problem.

Family Systems Medicine

The primary goal of Family Systems
Medicine is to view the patients problem
in multiple context

Family Systems in Clinical Practice

The family physician must be able to
understand first the basic concepts of
family structure and function.

Step 1
Recognize the Family Structure
Know the individual members of the family
A systematic way of obtaining and
recording this information is through the
use of a Family Genogram

Family Genogram
1. Family Tree

Must consist of 3 or more generations with

each generation identified by Roman numerals
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

2. Functional Chart
It gives a more dynamic image of the
family especially the relationship of each
member to other members. This allows
one to judge the familys totality as a unit,
its strengths and weaknesses, and its
adaptability in future stressful situations

3. Family Illness/History
This indicates the presence of
heredofamilial diseases in which
potential problems in the family can
arise.

Step 2
Understand the normal family function

5 Basic Family Functions

1. Provide support to each other
2. Establish autonomy and independence
for each person in the system
3. Create rules that govern the conduct of
the family and its members
4. Adapt to change in the environment
5. Communicate with each other

Functional Family
Defined as a family wherein a balance
between these functions is achieved.
Imbalances may result from over or under
emphasis of these functions.

Dysfunctional Family
Defined as a family with chronic inability to
respond to the needs or to cope with
changes and stresses in the environment

Step 3
Learn to assess Family Structure and
Function in Clinical Practice
Family assessment tools have been made
to aid the family physician in assessing the
family structure and function in clinical
practice.

Family Assessment Tools

Family Genogram
Family Circle
Family APGAR
FACES (Family Adaptability and Cohesion
Evaluation Scale)
FES (Family Environmental Scale)
Clinical Biography and Life Events
SCREEM
DRAFT (Draw A Family Test)
Family Mapping

Family Genogram
A graphic representation of a family tree
that displays detailed data about the
relationships among individuals in a family
Allows the user to analyze hereditary
patterns and psychological factors that
punctuate these relationships

Family Genogram
Quickly identify and understand various
patterns in the patient's family history
which may have had an influence on the
patient's current state of mind
Maps out relationships and traits that may
otherwise be missed on a pedigree chart

Family Genogram
An excellent tool to learn about the family structure but
has limited role in assessing the family functions. It
contains the following informations:
Names, gender, date of birth, date of death, and roles of
each family member
Divisions of an extended family into several households
Medical problems and chronic illnesses of each family
member
Significant dates in the family history
Nature of the family relationships

Veridiano Family
as of April 11, 2010
Project 4, Quezon City

1943

1947

Constantino, 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 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.
Difficulty of interpretation and
standardization poses as a disadvantage.

Family Circle
Dex

Mama Pesh

Mama
chuchi

Arra

Rihanne
Me
Ja

Kuya
Nel
Chok

Erin

Ate Tere

Family APGAR
This is a 5-question assessment tool used
for rapid assessment of family function
and dysfunction.
It measures an individuals 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 extrafamilial
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 patients behavior makes you suspect a
psychosocial problem possibly due to family
dysfunction.

FAMILY APGAR QUESTIONNAIRE

PART I
Helps define the degree of the patients
satisfaction or dissatisfaction with family
function

Part I
Almost
always
(2)

I am satisfied that I can turn to my family for

help when something is troubling me.

I am satisfied with the way my family talks

about things with me and shares problems
with me.

I am satisfied that my family accepts and

supports my wishes to take on new
activities or directions.

I am satisfied with the way my family

expresses affection and responds to my
emotions such as anger, sorrow, and love.

I am satisfied with the way my family and I

share time together.

Some of
the time
(1)

Hardly
ever
(0)

Filipino Family APGAR Part I

Palagi(
2)

Akoy nasisiyahan dahil nakakaasa ako ng tulong

sa aking pamilya sa oras ng problema.

Akoy nasisiyahan sa paraang

nakikipagtalakayan sa akin ang aking pamilya
tungkol sa aking problema.

Akoy nasisiyahan at ang aking pamilya ay

tinatanggap at sinusuportahan ang aking mga
nais na gawin patungo sa mga bagong landas
para sa aking ikauunlad.

Akoy nasisiyahan sa paraang ipinadadama ng

aking pamilya ang kanilang pagmamahal at
nauunawaan ang aking damdamin katulad ng
galit, lungkot, at pag-ibig.

Akoy nasisiyahan na ang aking pamilya at ako

ay nagkakaroon ng panahon sa isat-isa.

Paminsa
nminsan
(1)

Halos
hindi
(0)

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?

Name

Relationship

Age

How do you get along?

Well

Fairly

Poor

Sex

Part II

If you dont live with your

family, list down the persons
you turn to for help

How do you get along?

Name

Well

Relationship

Fairly

Age

Poor

Sex

Family APGAR
Scoring:
8-10 points = highly functional family
4-7 points = moderately dysfunctional
family
0-3 points = severely dysfunctional family

FACES
Family Adaptability and Cohesion
Evaluation Scale
This is an assessment tool based on the
Olsons circumflex model of family
function. The patient rates his family on a
30-item questionnaire on a 1-5 scale
which measures the adaptability and
cohesion of a family.

FES
Family Environment Scale
This is a tool developed by Moos which is
a 90-item questionnaire used as a
research tool to compare health care
results with family variables.

Clinical Biographies and 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.

SCREEM
An important tool to assess a familys
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

-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

- Ethnic and cultural inferiority

-cultural pride and satisfaction can be

identified
Religious
- Offers satisfying spiritual experiences as
well as contacts with an extra-familial
support group

- Rigid dogma/rituals

SCREEM
Economic
- 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
- 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

- Not utilizing health care

facilities/resources

DRAFT
Draw a Family Test
This is a simple, practical, and costeffective tool for assessing family
functions that can be administered
individually or in-group test.
Members of the family are given the
opportunity to express oneself and
consequently reveal innate difficulties
within the family system.

DRAFT
DRAFT has been found to be useful and
revealing because of the following reasons:
1.Evasive and guarded patients are more likely to
reveal their underlying traits because subjects
are more intellectually aware of what they may
reveal through verbal communication.
2.The unconscious label which represents
adultered basic needs can be expressed through
drawing.
3.Drawings are the first to show incipient
psychopathology and the last to lose the signs of
illness after patient recovery.

Family Assessment Model

I. Family Identification by its:

Composition- family members currently living

in the household, if they are kin or non-kin,
and their ages

Social History- social background of each

member regarding education, income,
occupation, marital status, ethnicity, and
culture

Community and Neighborhood- the general

tone of the neighborhood, its resources and
their availability, the affluence or meagerness
of the area, and the character of its residents

II. Individual and Family Data

Health history

Family dynamics- dysfunction is often

reflected in the health status of the
family

Family Mapping
This assessment tool was developed by a
psychiatrist-family therapist Salvador
Minuchin to facilitate the communication of
information about a family system to
colleagues through the use of symbols.

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 nonnegotiable

 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

Thank You!