FAMILY ASSESMENT TOOLS

dr. TA LARASATI, M.Kes

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 patient’s family to evaluate his
problem
 Step II

 Understand the family normal function

 5 Basic Family Function

 Provide support to each other

 Establish autonomy and independence for each
person in the system
 Create rules that govern the conduct of the family
and its members
 Adapt to change in the environment
 Communicate with each other
 Step 3

 Learn to assess Family Structure and Function in

Clinical Practice
 Family assesssment tools have been made to aid
the family physician in assessing the family
structure and function in clinical practice
 Different Family Assessment Tools

 Family Genogram
 Family Map
 Family APGAR
 SCREEM
 SCREEM Family Resource Survey (SCREEM-
Res)
 Family Lifeline
 Family Life Cycle
 Ecomap
 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
unity
 Family Map

 A tool designed to reflect family relationships

and interaction patterns
 This application is use for the communication of
information about the family system and I
dynamics in order to address psychosocial issues
 It also provides a schematic description on whom
to ask for assistance in making decisions for the
patient
 APGAR
 It is a tool that quality measures family functioning.
 It is a 10 to 15-minute paper and pencils technique that
elicits the patient’s perception and level of satisfaction on
the current state of her family member’s relationships
(Smilkstein, 1978)
 This is a 5 item questionnaire designed to elicit the
patient’s perception of the current state of his family
relationships and which serve as a rapid screening
instrument for family dysfunction.
APGAR
 4 Basic Situations where the
Family APGAR is needed
 When the family will be directly involved in
caring for the patient.
 When treating a new patient in order to get info
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 is also valuable in the
following conditions or situations :

 Symptoms that manifest themselves as psychosomatic

disorders.
 Difficult patients.
 Marital or sexual difficulties.
 Multiple presentations by multiple family members.
 Drug or alcohol abuse.
 Evidence of sexual and physical abuse on wife or a
child.
 Multiple presentations of a family member – “The thick
file syndrome”
 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
 APGAR Scoring
 Scoring
Almost always – 2
Some of the time – 1
Hardly ever – 0

 Total
8-10 – highly functional
4-7 – moderately dysfunctional
0-3 – severely dysfunctional
 SCREEM
 It is acronym that represents family resources and
is a tool where the family physician helps the
family members identify and assess their
resources to meet a crisis. If there is a lack of
resources, it can also serve as a kind of pathology
in certain situations.
 Relationships of health behavior, practices and
utilization of health services and barriers to
patient care.
 SCREEM
 It is commonly used when the need for care is
long or lasts a lifetime such as in the case of
chronically-ill, terminally-ill, and hospice care
patient.
 It can also be used to assess resources of difficult
and non-compliant patients
 SCREEM Family Resource
Survey (SCREEM-RES)
 It is 12 item self-administered family resources
questionnaire in Filipino based on SCREEM.
 It is a appropriate in assessing the family’s
capacity to participate in the provision of health
care or to cope with crisis (Corales & Medina,
2011).
 The format of the tool is user-friendly and
therefore, apt for a doctor in a busy Family
Practice.
 SCREEM Family Resource
Survey (SCREEM-RES)
 Family caregivers are asked to choose one of the following
responses :
• Strongly disagree
• Disagree
• Agree Strongly Agree

 The interpretation of SCREEM-RES is similar to the Family

APGAR where the sum of the scores is interpreted (Medina et al.
2011) :
• 0-6 = the family has severely inadequate family resources.
• 7-12 = moderately inadequate family resources.
• 13-18 = adequate family resources.
 Family Lifeline
 It is tool that summarizes the history of the family,
particularly the individual or the family’s significant
experiences over a period of time in a chronologically-
sequenced manner, and includes how the family has
coped with these stressful life events.
 The interpretation is based on the most significant
event that probably affected the health of each member
or influenced the health-seeking behavior or
perception on health of the individual or the family.
 Family Life Cycle
 This is a description of the family dynamics
through clearly defined stages of development.

 It provides a predictable and chronological

sequence of events in the family’s life, which can
be related to clinical events and to the health
maintenance of family members.
 ECOMAP
 It is a pictorial representation of a family’s
connections to persons and/or systems in their
environment.

 It’s purpose is to support classification of family

needs and decision making about potential
interventions, and it is to create shared a awareness
of the family’s significant connections and the
constructive influences those connections may be
having.
 ECOMAP

 It can illustrate 3 separate dimensions for each

connections :
 STRENGTH of the connection
 IMPACT of the connection
 QUALITY of the connection
ECOMAP is Necessary & Valuable because it :
 Enables a structures, consistent process for gathering specific, valuable
information related to the current state of a family or individual being
assessed
 Supports the engagement of the family in a dialogue.
 Indentifies and illustrates strengths that can built upon and weaknesses
that can be addressed.
 Summarizes complex data and information into a visual, easy to see and
understand format to support understanding and planning.
 Illustrate the nature of connections and the impact of interactions in pre-
defined “domain” areas.
 Provides a consistent base of information to inform and support
intervention decisions.
 Allows objective evaluation of progress.
 Helps support integration of the concept of family assessment as an
ongoing process.
 Reduces narrative in other parts of the family assessment process.
 Integrates the values and concepts in a practical way.
 Rules in Drawing the Ecomap
 At the center of the ecomap, a simplified view of the family
members in the household should be depicted, using Genogram
symbols and conventions.
 The intent is for each individual in the household to be addressed.
 There are some domains that will, for some families, apply at the
household level, or for all individuals in the family.
 Each individual can be “brought out of the center” into its own
circle and then domains that need to be addressed for the individual
can be.
 If a family or an individual is so complex that the ecomap becomes
messy, you can illustrate any individual or household on its own.
 Rules in Drawing the Ecomap
 Illustrate the existence of a connection and the
strength of it.
 Illustrate the impact of a connection, place an arrow
on the end of the line indicating whether resources and
energy are flowing to a person or away from a person.
 If a connection is stressful, illustrate with a jagged line
superimposed on the connection line.
 Brief summary comments may be written inside the
domain circles.
 Domains should be identified on the ecomap.
 Other Family Assessment Tools

 Draft (Draw a Family Test)

 The Family Circle
 DRAFT

 Draw a Family Test

 This is a simple, practical, and cost-effective 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
 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.
 Draw A Family Test
 It tells a lot about the patient’s feelings,
relationships they have with people around, self-
esteem and intellectual problems.
 A very informative method of getting to know the
patient especially when working with kids.
 Family Circle
 A brief, graphic method for disclosing, gathering and
discussing family dynamics as discussed by one or
more family members.
 Are often used in individuals but they can be applied
to small groups.
 Through this tool one can assess openness,
boundaries, support, function, triangulation and
interdependence in the family.
 Difficulty of interpretation and standardization poses
as a disadvantage.
 Level of Family Involvement

 Lastly, it is essential for family physician to know

how far they can go in assesssing family
dynamics and their relation to health care.
 Doherty et al. (1999) created a model of the five
levels of involvement with families.
 Five Levels of Family Involvement

 Level I : Minimal emphasis on the family in the

delivery of health care.

 Level II : Ongoing medical information and advise.

 Level III : Feelings and support.

 Level IV : Assessment of family dysfunction and provision of

intervention.

 Level V : Family Therapy

THANK YOU