DEFINITION OF THE FAMILY Sociologic Viewpoint

Enduring social form in which a person is incorporated

Biologic Viewpoint Genetic transmission

unit Psychologic Viewpoint

Matrix of personality development and the most intimate emotional unit of society

CHARACTERISTICS OF THE FILIPINO FAMILY

Closely knit Bilaterally extended Strong family orientation Authority based on

age/seniority Externally patriarchal,

internally matriarchal High value on education

of members

CHARACTERISTICS OF THE FILIPINO FAMILY

Predominantly Catholic(80% population)

Child centered Average members is 5 Environmental stresses:

economic, political, urbanization & industrialization, health problems

THE FAMILY AS A VERY SPECIAL UNIT Lifelong involvement Shared attributes

Genetics – physical/psychological Developmental – shared home, lifestyle &

social activities Sense of belonging

Security/defense against potentially hostile environment

Companionship

THE FAMILY AS A VERY SPECIAL UNIT Societal expectations

Sense of responsibility toward members and others Basis of affection/care

Built-in problems Generation gap Dependence on members Emotional attachment/involvement

The family endures in-spite of problems Resource utilization Authority Individual sense of responsibility

FAMILY STRENGTHS

Ability to provide family’s needs Physical – space

management, balanced meals, general health status

Emotional – helping members develop their capacity for sensitivity to each other’s needs

Spiritual/Cultural – sharing beliefs & cultural values

FAMILY STRENGTHS Child – rearing practices

and discipline Capacity of parents to

respect views on child rearing practices

If a Single Parent, the capacity of a single parent to be consistent and effective in raising children

FAMILY STRENGTHS Communication

Ability to communicate and express emotions verbally/non-verbally

Support, Security & encouragement Capacity to provide with feelings of security &

encouragement Balance in pattern of family activities

FAMILY STRENGTHS Responsible Community Relationships

Capacity to assume responsibility through participation in social, cultural or community activities

Self-Help & accepting Help Ability to seek & accept help when they need

it

FAMILY STRENGTHS Flexibility of Family Functions & Roles

Ability to “fill in” for one another during times of illness/when needed

Crisis as a means of Growth Ability to unite & become supportive during

crisis/traumatic experience

FAMILY AS A UNIT OF CARE THE FAMILY AS THE SOCIAL CONTEXT FOR

HEALTH CARE Transmission of infectious/communicable

diseases Health behavior requirements in the unit Resource utilization/source of support Health and illness definitions Health decisions/approaches and strategies

FAMILY AS A UNIT OF CARE THE PATIENT’S PROBLEM IS THE FAMILY’S

PROBLEM Doherty and McCubin, 1985: Important ways

in which the family plays a role in the health of its members: health promotion/maintenance and

illness/injury prevention coping with stressful life events family based health and illness appraisal

FAMILY STRUCTURE Nuclear

Members: parents & dependent children

Occupying separate dwelling not shared with members of the family of origin of either spouse.

The household is economically dependent, subsisting from the occupational earnings of husband/father

FAMILY STRUCTURE Extended Family

Unilaterally extended Bilaterally extended Includes 3 generations; family centered; lives

together as a group & through its kinship network provides support functions to all members

FAMILY STRUCTURE Single-Parent Family

Children < 17 yrs. old living in a family unit with a single parent, another relative, or non-relative

May result from loss of spouse by death, divorce, separation, desertion

Out-of-wedlock birth of a child From an adoption One parent is working outside the Philippines

(ocw, dhws etc.)

FAMILY STRUCTURE Communal/Corporate Family

Grouping of individuals formed for specific ideological or societal purposes

Considered as alternative lifestyle for people who feel alienated from the predominantly economically oriented society

BASIC AREAS OF FAMILY FUNCTION Biologic

Reproduction Child rearing/caring Nutrition Health maintenance Recreation

Economic Provision of financial resources Resources allocation Ensure financial security of member

BASIC AREAS OF FAMILY FUNCTION Educational

Teach skills, attitudes and skills relating to other functions

Psychologic/ Affection Promotes natural development of personality Offer optimum psychological protection Promotes ability to form relationship with

people in family circle Socio-Cultural

Socialization of children Promotion of status and legitimacy

ORDINAL POSITION (DIFFERENCES IN

BEHAVIOURS) First Born – generally persevering

Serious More responsive to adults Achievement oriented

Middle Child - optimistic Sociable Aggressive Competitive Occasionally manipulative

Youngest - demanding Outgoing Occasionally narcissistic By nature are affectionate

FAMILY SOCIAL CLASS PATTERNS Upper Class

much more closely knit greater concern for maintaining for family

name & prestige Middle Class

believes in hard-work, initiative, independence, responsibility, economic security & self improvement through education

Lower Class sees life as continual struggle for survival resigned to a life of frustration and defeat

FAMILY SET-UP Democratic

Parents respect child’s decision/idea Understanding & permissiveness prevail

Authoritarian Unquestioned obedience conformity to

Parental guidance Pattern of punishment than praise Patients with Low self-reliance Suspicious adults Stand poorly in stressful situation Become hostile with pain/discomfort

Marikka Villafuerte-Solana, MDSan Beda College of Medicine

Objectives of the Session Learn to incorporate a family systems

approach to clinical practice Understand the different tools of family

assessment Apply/ use the tools of family assessment

in clinical practice

Family Systems Approach to Patient Care Better health care results if family

relationships, social and cultural systems are all considered

Can facilitate a new level of understanding of a patient’s problem

Requires understanding the structure and function of the family

Incorporating a Family Systems Approach into

Clinical Practice

STEP 1- Know the Individuals/Members of the Family

Know the individuals in the family Obtain the following information

Names of members Place of residence Specific roles in the family Stage of the family life cycle Significant dates in the family

(marriage, birth, death, etc)

STEP 1- Know the Individuals/Members of the Family

THE FAMILY GENOGRAM A graphic representation of the genetic

pedigree, psychosocial, and interactions within the family

Three features:The family treeFunctional ChartFamily illnesses/ history

STEP 2- Understand Normal Family Functions

Provide support to each other Establishing independence to enhance

personal growth of each member Create rules that govern the conduct of

each member Adaptation to change Communication with each other

Smilkstein’s Cycle of Family Function

Family in functional equilibrium

(Functional or nurturing)

Stressful Life event

Family in disequilibrium

Resources adequate

Adaptation (coping)

Resources inadequate

Crisis

Maladaptation

Extra-familial resources

Pathologic defense mechanism Stressf

ul life event

Pathologic disequilibriumTerminal disequilibrium

STEP 3- Assess Family Structure and Function

Tools of Family Assessment Family Genogram Family Map Family Circle Family APGAR SCREEM DRAFT (Draw a Family test) Life Line (Clinical biographies and life

events)

Uses of the family genogram Records names and roles of each member of

the family Separates extended family into several

household Documents medical problems of each

member of the family Documents significant dates in the family

history

The Family Tree Consists of three generations The first-born of each generation is farthest to

the left The family name is placed above each major

family unit Given names and ages are placed below each

symbol Index patient is identified with an arrow Date is indicated when the chart was

developed

C

ESPINOSA- REFULGENTE FAMILY

C

JOLENE

54

Ernesto Efron

48Rizza

30

Jun

57

Joy

25

Ayn

20

MAE

23

Reid

1

BRAYN

25

Ivy

18

Lucil

22

Hazel

21

Salva

17

C- cancer

T- tb

H- hepatitis

- HPN

A- asthma

HT A

May 19, 2003

I

III

II

SOLANA-VILLAFUERTE FAMILY

PP

4 4 6

Nov. 25, 2007

I

II

III

Heart disease

Diabetes

Asthma

Manding

Victoria

Amy

Nene Julie

Junilyn

28

Lydia

Lester

Mien

Imelda Elizabeth Grace

Graciano

82

Remedios

65

David

58

Tess

55

Justin

39

Mek

33

Thea

2 mos

Nanay Puring

58

Michael

Reggie

31Hearty

28

Chai

3

Jhay

22

Bhen

20

George

HPNStroke

Mandy

28

P Provider

C Caregiver

DEVELOPED BY Salvador Minuchin, a Psychiatrist-Family Therapist

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

Functional/close relationship Indicates dysfunction Over-involved relationship Rigid boundary where the rules

are clear but not negotiable Boundary that is clear but

negotiable Boundary that is diffuse or unclear Coalition or alliance Escape from the system

Conflictual relationship Distant relationship Dominant relationship Marital discord Divorce, mother has custody of

two girls Solid or dashed line indicating

individuals living together

C

ESPINOSA- REFULGENTE FAMILY

JOLENE

54Ernesto

Efron

48 Rizza

30

Jun

57

Joy

25

Ayn

20

MAE

23

Reid

1

BRAYN

25

Ivy

18

Lucil

22

Hazel

21

Salva

17

C- cancer

T- tb

H- hepatitis

- HPN

A- asthma

HT A

May 19, 2003

I

III

II

  

JOLENE

Efron

Joy

Ayn

Ivy

BRAYN

Hazel

Salva

Lucil

Rizza

Jun

MAE

The Family Physician draws a large circle on a piece of paper and instructs the patient to draw small circles representing himself and each member of his family

MamaHearty

Chai

JhayBhen

Mek

Thea Justin

Papa

Reggie

Daday

Juni

Nanay Purs

Consists of five questions that assess family function

Rapid screening instrument for family dysfunction

Measures the individual’s level of satisfaction about family relationship

Part I helps define degree of patient’s satisfaction w/ family

Part II delineates relationship w/ other members, and identifies people who can give assistance to the patient

Scores of 8-10 points= highly functional family

4-7= moderately dysfunctional 0-3= severely dysfunctional

Situations where the APGAR is needed When the family will be directly involved

in caring for the patient When treating a new patient, in order to

assess family function When treating a patient whose family is in

crisis When a patient’s behavior makes you

suspect a psychosocial problem due to family dysfunction

Almost Always 2

Some of the time 1

Never 0

Adaptation Capability of the family to share inherent resources

Partnership Sharing of decision making

Growth Freedom to change

Affection How emotions like love, anger, hatred are shared between members

Resolve How time, space, money, are shared

MAE( Part I) PALAGI 2

Paminsan-minsan 1

Halos Hindi 0

Adaptation Nasisiyahan ako dahil nakaaasa ako ng tulong sa aking pamilya sa oras ng pangangailangan

Partnership

Nasisiyahan ako sa paraang nakikipagtalakayan sa akin ang aking pamilya tungkol sa aking

mga problema

Growth Nasisiyahan ako dahil ang aking pamilya ay tinatanggap at sinusuportahan ang aking mga nais na gawin patungo sa mga bagong landas para sa aking ikauunlad

Affection Nasisiyahan ako sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot, at pag-ibig

Resolve Nasisiyahan ako na ang aking pamilya at ako ay nagkakaroon ng panahon sa isat-isa

Shows the capacity of the family to participate in the provision of health care or to cope with crisis

Each factor can be considered as a resource or a pathology

RESOURCES PATHOLOGY

SOCIAL >>family has many friends >mother teaches in a nearby elem school >member of the KABAKA

>social interaction not that evident>misunderstanding with husband

CULTURAL Mae’s mother believes in faith healers which hinders her medical management

RELIGION Family is a pure Catholic and mother is active in church activities

Mae doesn’t go to church often.

RESOURCES PATHOLOGY

EDUCATION Mae is a graduate of Civil Engineering. A consistent achiever since elem days.

ECONOMICS Mae works as an asst. professor before she got sick. Husband and mother works but earns just enough for their everyday needs.

Family wasn’t able to save for Mae’s chemotherapy

MEDICAL Health care is readily available. >near PGH >bgy health center >private doctor

Mother believes in faith healers, and instead of bringing Mae to a doctor, she brought Mae to albularyos first

Provides clues on the individual members of the family w/ regards their personalities

Members of the family find the opportunity for self-expression, thus revealing and relieving innate difficulties w/in the family systems

The individual’s experiences with health and sickness are connected with his personal life

If life events and clinical events are put side by side accdg to dates of occurrence, the correlation between the two can be shown

     

May,1980 Mae was born to Jolene and Ernesto

Childhood days

Feb, 1998 Mae met Brayn

College Years

Happy days

    

Oct, 2000

Aug, 2002

Espinosa-Refulgente wedding

Birth of Reid

Disillusionment about the wedding

Return to mother for comfort

Feb, 2003 Medical illness

Feb, 2004 Death

ASSIGNMENT Make your own family genogram in

three generations, APGAR, SCREEM, and family circle