Orientation on Orientation on Family Assessment Family Assessment
Family Wellness PlanningFamily Wellness Planning
Dept of Family and Community Medicine
UP College of Medicine
FCH 260.1
General ObjectivesGeneral Objectives
To be able to formulate and implement a family-oriented, patient-centered, and community-based health management plan for an index patient, taking into consideration the totality of his being and wellness of the family.
Specific ObjectivesSpecific ObjectivesTo formulate, implement, and discuss a patient-centered health management plan.
To describe the family psychodynamics using widely used family assessment tools.
To discuss the social environment, its resources, and hindrances to a successful wellness plan
To be able to formulate family wellness plans
To critically appraise a related journal article and show its application to the case/community
The Person, His Family, and CommunityThe Person, His Family, and Community
World/Universe
Nation
Community
Family
Family
Community
Nation
World/Universe
Family-Oriented Primary CareFamily-Oriented Primary Care
Rose is a 32-yr old presenting with severe depression. She has been married to Ken for 13 years. There are 2 children: Luke, 12 and Candy, 10.
Rose is a 32-yr old woman presenting with severe depression. She has been married to Ken for 13 years. There are 2 children, Like, 12, and Candy, 10. Ken and children accompany Rose to therapy expressing the desire to help her and themselves. They report having recently moved to the area. Their new home is out in the country with no close neighbors. They all express missing their friends and disliking the isolation they currently experience.
Family Oriented Health CareFamily Oriented Health Care
The family as a whole is your object of management
Encompasses all ages, both sexes, each organ system, every disease entity
It is about the biopsychosocial wellness of every member of the family
• PAFP, 1999
Definitions of the FamilyDefinitions of the Family
Sociologic
Biologic
Psychologic
The enduring social form in which a person is incorporated
Genetic transmission unit
Matrix of personality development
The most intimate emotional unit of society
Roles of Family Members in the Roles of Family Members in the Health of its Members:Health of its Members:
Health promotion/maintenance Illness/ injury preventionCoping with stressful life eventsFamily based health and illness appraisalFamily interaction and level of functioning in
response to specific illness
Roles of Family Members in the Roles of Family Members in the Health of its Members:Health of its Members:
Help seeking or deciding on the issue of seeking medical support
Family adaptation/coping with illness Caregiving Adherence to prescribed treatment Lifestyle modification
HealthHealth
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"
Include the ability to lead a "socially and economically productive life".
• World Health Organization Constitution, 1946
The Biopsychosocial ModelThe Biopsychosocial Model
The World
SOCIAL SYSTEMS
Examples of systems included:SocietyFamilyCommunity
The Person
BIOLOGICAL SYSTEMS Genetics and Physiology
Examples of systems included:
OrgansTissuesCells
PSYCHOSOCIAL SYSTEMS
Experience & Behavior
Examples of systems included:
Cognition Emotion Motivation
BADL
YRS
CBA
LEVELS OF FUNCTIONING
50 70 80 90 100 11060
OPTIMAL FUNCTION
Advanced Life Pursuits
Homemaking
Self-care
Dmdcamagay, 2006
IADL
AADL
Family AssessmentFamily Assessment
Recognition of the family’s strengths and weaknesses in the face of a crisis through the use of standardized tools for the purpose of implementing interventions—pharmacologic, behavioral, education, counseling, referral, etc – which will be part of the Family Wellness Plan.
Characteristics of the FamilyCharacteristics of the Family
Structure
Areas of Functioning
Nuclear, extended, single-parent or blended
Biologic Economic Education Psychologic/Affection Socio-cultural
Family Psychodynamics and Family Psychodynamics and Effects on HealthcareEffects on Healthcare
Ordinal Position
Family Socioeconomic Class Patterns
First Born Middle Child Youngest
Upper Class Middle Class Lower Class
Family Psychodynamics and Family Psychodynamics and Effects on HealthcareEffects on Healthcare
Family Set-up
Parent-Child /Sibling-Sibling Interaction
Democratic Authoritarian
Symptom-carrier? Caregiver? Follower? Devil’s Advocate?
Family Assessment ToolsFamily Assessment Tools
Family
Genogram
Identifies Structure– Nuclear, Extended, Single-parent, Blended,
Communal Documents health risks/medical problems of each
member Records names/ages/deaths of each family
member Reveals more subtle information about the family
Torres- Uy FamilyTorres- Uy Family
25 December, 2007
THE FAMILY LIFE CYCLE AND LENGTH THE FAMILY LIFE CYCLE AND LENGTH OF TIME IN EACH STAGEOF TIME IN EACH STAGE
60
0
0
40
married couples
childbearing families
families with pre-school
families with schoolchildren
families with teenagers
families with launchingyoung adults
middle-aged parents
aging family members
10-15 yrs
15 yrs
8 yrs
7 yrs
7 yrs
3.5 yrs
2.5 yrs2 yrs
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
MARRIED COUPLE
Wife Husband
Establishing a mutually satisfying marriage
Fitting into the kin network Adjusting to pregnancy and
parenthood Family planning Infertility
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
CHILDBEARING
Wife-Mother Husband-Father Infant Daughter or
son
Having, adjusting to and encouraging the development of infants
Establishing a nurturing/satisfying home for both parents and infants
Breastfeeding Infant immunizations Family Planning Safe pregnancy and delivery
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
PRESCHOOL AGE
Wife-Mother Husband-Father Daughter-Sister Son-Brother
Nurturing the growth of pre-school children in stimulating growth-promoting ways
Coping with energy depletion and lack of privacy as parents
Immunizations Accident and injury
prevention Deworming
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
SCHOOL AGE
Wife-Mother Husband-Father Daughter-Sister Son-Brother
Fitting into the community of school-age families in constructive ways
Encouraging children’s educational achievement
Immunizations Accident and injury prevention Infectious and communicable
diseases
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
TEEN-AGE
Wife-Mother Husband-Father Daughter-Sister Son-Brother
Balancing freedom with responsibility as teenagers mature and emancipate themselves
Establish postparental interests and careers as growing parents
Sex education and STD Teenage pregnancy
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
LAUNCHING
Wife-Mother-Grandmother
Husband-Father-Grandfather
Daughter-sister-aunt-mother
Son-brother-uncle-father
Releasing young adults into work, military service, college, marriage, etc. with appropriate rituals and assistance
Maintaing a supportive home base
Empty nest syndrome Chronic illnesses of adulthood
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
Middle-aged Parents
Wife-Mother-Grandmother
Husband-Father-Grandfather
Rebuidling the marriage relationship
Maintaining kin ties with older and younger generations
Establishing meaningful relationships with peers
Chronic illnesses of adulthood
Stages of the Family Life CycleStages of the Family Life CyclePositions, Tasks and Health IssuesPositions, Tasks and Health Issues
AGING FAMILY
Widow/widower Husband-Grandfather Wife-Grandmother
Coping with bereavement and living alone
Maintaining functional independence
Adapting to aging and frailty Adjusting to retirement Degenerative diseases
Family Assessment ToolsFamily Assessment Tools
Family
APGAR
A-daptation
P-artnership
G-rowth
A-ffection
R-esolve
Rapid screening tool for family dysfunction.
Normal 8-10Moderately Dysfunctional 6-7Severely Dysfunctional <5
Family Assessment ToolsFamily Assessment Tools
Family
Map (Salvador
Minuchin)
Family Assessment ToolsFamily Assessment Tools
Family
SCREEM
Resources Pathololides
S - ocial
C - cultural
R - eligious
E - conomic
E - ducational
M- edical
Family Assessment ToolsFamily Assessment Tools
Family Lifeline
Impact of Illness on the Family
Timeline of events
I – Onset of illness /impact of illness
II -Impact of the diagnosis III - Major Therapeutic
Efforts IV - Recovery Phase V-Adjusting to the
Permanency of the Outcome
Rapid Community Med Rapid Community Med CheckCheck
Community Resources available?Healthcare Delivery SystemDistance of the Family from the resources
WELLNESS MODEL
TREATMENT MODEL
DISABILITYSYMPTOMS SIGNS AWARENESS EDUCATION GROWTH
NEUTRAL POINT
THE ILLNESS-WELLNESS CONTINUUM
Family Wellness PlanFamily Wellness Plan
Incorporates family assessment in clinical practice
One-on One basis for every memberIncludes health promotion and all stages of
prevention strategies, if applicableIncludes age- specific periodic health
examination of every member
A Related Journal AppraisalA Related Journal Appraisal
Application of knowledge of critical appraisal of a journal based on the index case
Appreciation of the information gatheredApplication of the journal to the index case
or to family medicine in general
SUMMARYSUMMARY Chose and managed an index case in the community Identified and utilized various family assessment tools
to describe the psychodynamics of the family of the index case and the role of the family in their health status
Described the community and noted the influence of the environment on the heatlh of the constituents
Formulated wellness plans for the index case and the family members
Critically appraised a journal related to the case
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