33010802 tools-for-family-assessment

TOOLS IN FAMILY TOOLS IN FAMILY ASSESSMENTASSESSMENT

Patient coming in to the clinic with Patient coming in to the clinic with health problem health problem cannot be fully cannot be fully understoodunderstood if only the pathophysiology if only the pathophysiology of medical problem is consideredof medical problem is considered

Family relationship + family social Family relationship + family social system + family cultural system = system + family cultural system = better evaluation & better health carebetter evaluation & better health care

Family systems Family systems approach toapproach to common common clinicalclinical situation can facilitate a new situation can facilitate a new levellevel of understanding of patient’s of understanding of patient’s problemproblem

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

Steps in Incorporating Steps in Incorporating Family Systems Approach Family Systems Approach

into Clinical Practiceinto Clinical Practice STEP 1STEP 1

RECOGNIZE FAMILY RECOGNIZE FAMILY STRUCTURESTRUCTURE


RECOGNIZING FAMILY RECOGNIZING FAMILY STRUCTURESTRUCTURE

know individuals in the familyknow individuals in the family

names, place of residence, specific names, place of residence, specific roles in the family, stage of family in roles in the family, stage of family in family life cycle, significant dates in family life cycle, significant dates in the familythe family

complete a family genogramcomplete a family genogram


FAMILY GENOGRAMFAMILY GENOGRAM

Very excellent tool in learning about family Very excellent tool in learning about family structurestructure

Records names and roles of each member Records names and roles of each member of the familyof the family

Separates extended family into several Separates extended family into several householdhousehold

Documents medical problems of each Documents medical problems of each member of the familymember of the family

Documents significant dates in the family Documents significant dates in the family historyhistory


FAMILY GENOGRAMFAMILY GENOGRAM

Graphic representation of following Graphic representation of following components of a family:components of a family:

1. Family Tree1. Family Tree

2. Functional Chart2. Functional Chart

3. Family illness/History3. Family illness/History


malemale deathdeath

femalefemale index patientindex patient

spontaneous abortionspontaneous abortion marital discord & GFmarital discord & GF

pregnancypregnancy adoptedadopted

cause of deathcause of death marriage and yearmarriage and year

separation & yearseparation & year not marriednot married

conflictual relationshipconflictual relationship distant relationshipdistant relationship

close relationshipclose relationship overly closeoverly close

dominant relationshipdominant relationship marital discordmarital discord

A

2005

1968


FAMILY TREEFAMILY TREE Must contain 3 or more generations, each

identified by a Roman numeral 1st born of each generation is farthest to

left, with siblings following to right in order of birth

Family name placed above each major family unit

Given names and ages are placed below each symbol

One member of family is of greater medical significance because of an illness (index patient, identified with an arrow)

Date is indicated when chart was developed so ages would be adjusted over time


FUNCTIONAL CHARTFUNCTIONAL CHART

Gives a more Gives a more dynamic imagedynamic image of family of family Allows one to judge totality of family Allows one to judge totality of family

unit (strengths & weaknesses, ability to unit (strengths & weaknesses, ability to withstand future stressful situations)withstand future stressful situations)


FAMILY FAMILY ILLNESS/HISTORYILLNESS/HISTORY

Denotes presence of inherited Denotes presence of inherited diseases or familial tendencies diseases or familial tendencies indicating potential problems in the indicating potential problems in the familyfamily


Ben,43 1942

Maria,78

2003

Salvador,63

2000

Vicenta,52

1996

COLANSE PIEDRA

Berto 48

Celso 46

Erdul,44

Jojo 41

Monch 37

Pepe 35

Gil 32

Samuel 29

Evelyn,49

Erlyn, 23 Mayet, 22 Nina,19

I

II

III

cancer

allergy

cardiac pathology

asthma

Colanse-Piedra Colanse-Piedra FamilyFamily

June 28,2008June 28,2008

↑

Cris, 25 Bert,20 Don, 27

STEP 2STEP 2

UNDERSTANDING NORMAL UNDERSTANDING NORMAL FAMILY FUNCTIONFAMILY FUNCTION


Basic Family FunctionsBasic Family Functions

Provide support to each otherProvide support to each other

Establish autonomy & independence for Establish autonomy & independence for each personeach person

Create rules governing conduct of family & Create rules governing conduct of family & of individuals within the familyof individuals within the family

Adapt to change in environmentAdapt to change in environment

Communicate with each otherCommunicate with each other


STEP 3STEP 3

LEARNLEARN TO ASSESS TO ASSESS FAMILYFAMILY STRUCSTRUCTURE AND FUTURE AND FUNCTIONNCTION

IN IN CLINICAL PRACCLINICAL PRACTICETICE


FAMILY ASSESSMENT FAMILY ASSESSMENT INSTRUMENTSINSTRUMENTS

1.1. Family GenogramFamily Genogram

2.2. Family CircleFamily Circle

3.3. Family MapFamily Map

4.4. Family APGAR by SmilksteinFamily APGAR by Smilkstein

5.5. Clinical Biography and Life EventsClinical Biography and Life Events

6.6. SCREEMSCREEM


Family Circle

A graphic method

for disclosing dynamics of family interaction using circles.


FAMILY CIRCLEFAMILY CIRCLE

M OMMY

PAPA

MELVIN

NINABATZ

NANANG

JULIUS

MAYET

Taken from the “Daffodil” case presentation

FAMILY MAPFAMILY MAP

Developed by Salvador Minuchin Developed by Salvador Minuchin (Psychiatrist-Family therapist)(Psychiatrist-Family therapist)

Facilitates communication of Facilitates communication of information about a family system to information about a family system to colleagues so that they can be colleagues so that they can be understoodunderstood


functional relationshipfunctional relationship

dysfunctiondysfunction

over-involved relationship with plenty of over-involved relationship with plenty of intrusionintrusion

rigid boundary where rules are clear but non-rigid boundary where rules are clear but non-negotiablenegotiable

clear boundary but negotiableclear boundary but negotiable

boundary that is diffuse or unclearboundary that is diffuse or unclear

presence of coalition or alliance between these presence of coalition or alliance between these peoplepeople

escape from the systemescape from the system

third person is triangulated by conflict between third person is triangulated by conflict between the the other 2other 2


Taken from the “Daffodil” case presentation

FAMILY APGARFAMILY APGAR

Rapid screening test instrument for Rapid screening test instrument for family dysfunctionfamily dysfunction

Has adequate reliability and validity Has adequate reliability and validity to measure individual’s level of to measure individual’s level of satisfaction about family satisfaction about family relationshipsrelationships


FAMILY APGARFAMILY APGAR

AA ADAPTATIONADAPTATION PP PARTNERSHIPPARTNERSHIP GG GROWTHGROWTH AA AFFECTIONAFFECTION RR RESOLVERESOLVE


ADAPTATIONADAPTATION Capability of family to utilize & share inherent Capability of family to utilize & share inherent

resources (intra/extra-familial)resources (intra/extra-familial)

PARTNERSHIPPARTNERSHIP Sharing of decision-making; measures satisfaction Sharing of decision-making; measures satisfaction

attained in solving problems by communicatingattained in solving problems by communicating

GROWTHGROWTH Physical & emotional growth; measures satisfaction of Physical & emotional growth; measures satisfaction of

available freedom to changeavailable freedom to change

AFFECTIONAFFECTION How love, anger, hatred are shared between How love, anger, hatred are shared between

members; measures members’ satisfaction with members; measures members’ satisfaction with intimacy & emotional interaction existing in the familyintimacy & emotional interaction existing in the family

RESOLVERESOLVE How time, money, space are shared; measures How time, money, space are shared; measures

members satisfaction with commitment by other members satisfaction with commitment by other members of familymembers of familyPineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40

When is Family APGAR When is Family APGAR needed?needed?

1.1. When family is directly involved in When family is directly involved in caring for the patientcaring for the patient

2.2. When treating a new patient in When treating a new patient in order to serve as general view of order to serve as general view of family functionfamily function

3.3. When treating a patient whose When treating a patient whose family is in crisisfamily is in crisis

4.4. When patient’s behavior makes you When patient’s behavior makes you suspect a psychosocial problem suspect a psychosocial problem possible due to family dysfunctionpossible due to family dysfunction


ALMOST ALMOST ALWAYSALWAYS

Score = Score = 22

SOME OF SOME OF THE THE TIMETIME

Score = Score = 11

HARDLY HARDLY EVEREVER

Score = Score = 00

AA I am satisfied that I can I am satisfied that I can turn my family for help turn my family for help when something is when something is troubling metroubling me

PP I am satisfied with the way I am satisfied with the way my family talks on things my family talks on things with me & shares with me & shares problems with meproblems with me

GG I am satisfied that my I am satisfied that my family accepts & supports family accepts & supports my wishes to take on new my wishes to take on new activities or directionactivities or direction

AA I am satisfied with the way I am satisfied with the way my family expresses my family expresses affection & responds to affection & responds to my emotion such as my emotion such as anger, sorrow & loveanger, sorrow & love

RR I am satisfied with the way I am satisfied with the way my family and I share time my family and I share time togethertogether

Parameters


SCORING:SCORING:

8 – 108 – 10 HIGHLY FUNCTIONALHIGHLY FUNCTIONAL

4 – 74 – 7 MODERATELY DYSFUNCTIONALMODERATELY DYSFUNCTIONAL

0 – 30 – 3 SEVERELY DYSFUNCTIONALSEVERELY DYSFUNCTIONAL


CLINICAL CLINICAL BIOGRAPHY &BIOGRAPHY & LLIFE IFE EVENTSEVENTS

Valuable tools which can facilitate Valuable tools which can facilitate analysis of connectionanalysis of connection

Individual’s experiences with health Individual’s experiences with health and sickness are connected with his and sickness are connected with his personal lifepersonal life


Example (taken from “Daffodil” case Example (taken from “Daffodil” case presentation)presentation)

1982 - Childhood years 1982 - Childhood years 1983 - Sibling Rivalry1983 - Sibling Rivalry1990 - “ First love”1990 - “ First love”

- Financial Difficulties- Financial Difficulties1992 - Sexually Violated1992 - Sexually Violated19971997 - Met Bobby - Met Bobby Common-law relationshipCommon-law relationship1999 - 21999 - 2ndnd pregnancy pregnancy2000 - 32000 - 3rdrd pregnancy pregnancy - Resignation of Bobby- Resignation of Bobby2001 - “Guest Relations Officer”2001 - “Guest Relations Officer”

2002 - “New boyfriend” 2002 - “New boyfriend” 4 4thth pregnancy pregnancy

2004 - 52004 - 5thth pregnancy pregnancy - Reconciliation with Bobby- Reconciliation with Bobby

2005 - Financial problems2005 - Financial problems

2006 - Vaginal bleeding2006 - Vaginal bleeding - Hospitalized - Hospitalized Cervical Cancer Cervical Cancer

SCREEMSCREEM Important as to assess family’s Important as to assess family’s

capacity to participate in provision capacity to participate in provision of health care and its capacity to of health care and its capacity to cope with crisis cope with crisis


SCREEMSCREEMRESOURCERESOURCE

SSOCIALOCIAL

Social interaction is evident among family members. Social interaction is evident among family members. Family members have well-balanced lines of Family members have well-balanced lines of

communication with extra-familial social groups.communication with extra-familial social groups.

CCULTURALULTURAL

Cultural pride or satisfaction can be identified, Cultural pride or satisfaction can be identified, especially in distinct ethnic groups.especially in distinct ethnic groups.

RRELIGIOUSELIGIOUS

Religion offers satisfying spiritual experiences as Religion offers satisfying spiritual experiences as well as contacts with an extra-familial support well as contacts with an extra-familial support

group.group.

EECONOMICCONOMIC

Economic stability is sufficient to provide both Economic stability is sufficient to provide both reasonable satisfaction with financial status and an reasonable satisfaction with financial status and an ability to meet economic demands of normative life ability to meet economic demands of normative life

events.events.

EEDUCATIONDUCATION

ALAL

Education of family members is adequate to allow Education of family members is adequate to allow members to solve or comprehend most of the members to solve or comprehend most of the

problems that arise within the format of the life style problems that arise within the format of the life style established by the familyestablished by the family

MMEDICALEDICAL

Health care is available through channels that are Health care is available through channels that are easily established and have previously been easily established and have previously been

experienced in a satisfactory mannerexperienced in a satisfactory mannerPineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48

33010802 tools-for-family-assessment

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