Presentation on theme: "Tools in Family Assessment"— Presentation transcript:
1 Tools in Family Assessment JI Veridiano,Ofelia S.
2 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 familyIt will depend on the family physician as to up to what level he will involve a patient’s family to evaluate his problem.
3 Family Systems Medicine The primary goal of Family Systems Medicine is to view the patient’s problem in multiple context
4 Family Systems in Clinical Practice The family physician must be able to understand first the basic concepts of family structure and function.
5 Step 1 Recognize the Family Structure Know the individual members of the familyA systematic way of obtaining and recording this information is through the use of a Family Genogram
6 Family Genogram Family Tree Must consist of 3 or more generations with each generation identified by Roman numeralsThe first born of each generation is farthest to the left with the following siblings going to the right according to order of birthFamily name is placed above each major family unit
7 Names and ages written below the symbol Index patient is identified with an arrowDate must be indicated when it was made to be able to adjust the ages over time
8 2. Functional ChartIt gives a more dynamic image of the family especially the relationship of each member to other members. This allows one to judge the family’s totality as a unit, its strengths and weaknesses, and its adaptability in future stressful situations
9 3. Family Illness/History This indicates the presence of heredofamilial diseases in which potential problems in the family can arise.
11 5 Basic Family Functions Provide support to each otherEstablish autonomy and independence for each person in the systemCreate rules that govern the conduct of the family and its membersAdapt to change in the environmentCommunicate with each other
12 Functional FamilyDefined as a family wherein a balance between these functions is achieved. Imbalances may result from over or under emphasis of these functions.
13 Dysfunctional FamilyDefined as a family with chronic inability to respond to the needs or to cope with changes and stresses in the environment
14 Step 3Learn to assess Family Structure and Function in Clinical PracticeFamily assessment tools have been made to aid the family physician in assessing the family structure and function in clinical practice.
15 Family Assessment Tools Family GenogramFamily CircleFamily APGARFACES (Family Adaptability and Cohesion Evaluation Scale)FES (Family Environmental Scale)Clinical Biography and Life EventsSCREEMDRAFT (Draw A Family Test)Family Mapping
16 Family GenogramA graphic representation of a family tree that displays detailed data about the relationships among individuals in a familyAllows the user to analyze hereditary patterns and psychological factors that punctuate these relationships
17 Family GenogramQuickly identify and understand various patterns in the patient's family history which may have had an influence on the patient's current state of mindMaps out relationships and traits that may otherwise be missed on a pedigree chart
18 Family GenogramAn 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 memberDivisions of an extended family into several householdsMedical problems and chronic illnesses of each family memberSignificant dates in the family historyNature of the family relationships
19 Veridiano Family as of April 11, 2010 Project 4, Quezon City Constantino, ■ Mila Fatima ∆2007Thess 42 ♥ Nel May 39 ♦ Jojo 44 ♥ Peng 27 ♥∆ Ruptured aneurysm■ Heart failure♥ Hypertension♦ Bronchial AsthmaChok 36 ♦ Tere 38Ja 4 ♦
20 Family CircleFamily 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.
21 Family Circle Dex Mama Pesh Mama chuchi Arra Rihanne Me Ja Kuya Nel ChokJaKuya NelDexArraErinAte TereRihanne
22 Family APGARThis is a 5-question assessment tool used for rapid assessment of family function and dysfunction.It measures an individual’s level of satisfaction about family relationships.
23 Family APGARAdaptation- the ability of a family to use and share inherent resources which can be either intra- or extra-familialPartnership- the sharing of decision making which measures the satisfaction of solving problems through communicatingGrowth- pertains to both physical and emotional aspects and measures the satisfaction of the freedom to changeAffection- emotions that are shared with and between family members which measures the satisfaction with the intimacy and emotional interaction that exist in the familyResolve- refers to how time, money, and space are shared; this measures the satisfaction with the commitment made by members of the family
24 Family APGARThere 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 functionWhen treating a patient whose family is in crisis.When a patient’s behavior makes you suspect a psychosocial problem possibly due to family dysfunction.
25 FAMILY APGAR QUESTIONNAIRE PART I Helps define the degree of the patient’s satisfaction or dissatisfaction with family function
26 Part IAlmost always (2)Some of the time(1)Hardly ever(0)AI am satisfied that I can turn to my family for help when something is troubling me.PI am satisfied with the way my family talks about things with me and shares problems with me.GI 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.RI am satisfied with the way my family and I share time together.
27 Filipino Family APGAR Part I Palagi(2)Paminsan-minsan (1)Halos hindi(0)AAko’y nasisiyahan dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng problema.PAko’y nasisiyahan sa paraang nakikipagtalakayan sa akin ang aking pamilya tungkol sa aking problema.GAko’y nasisiyahan at ang aking pamilya ay tinatanggap at sinusuportahan ang aking mga nais na gawin patungo sa mga bagong landas para sa aking ikauunlad.Ako’y nasisiyahan sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot, at pag-ibig.RAko’y nasisiyahan na ang aking pamilya at ako ay nagkakaroon ng panahon sa isa’t-isa.
28 Family APGAR Part IIDelineates relationships with other members, identifies persons who can give assistance to the patient, and indicates conflicts not revealed in part I
29 Part II Who lives in your home? Name Relationship Age Sex How do you get along?WellFairlyPoor
30 Part IIIf you don’t live with your family, list down the persons you turn to for helpHow do you get along?NameRelationshipAgeSexWellFairlyPoor
31 Family APGAR Scoring: 8-10 points = highly functional family 4-7 points = moderately dysfunctional family0-3 points = severely dysfunctional family
32 FACES Family Adaptability and Cohesion Evaluation Scale This is an assessment tool based on the Olson’s 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.
33 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.
34 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.
35 SCREEMAn important tool to assess a family’s 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.
36 SCREEM Resource Pathology Social Cultural social interaction is evident among family membersFamily members have well-balanced lines of communication with extra-familial social groupsIsolated from extra-familialProblem of over commitmentCultural-cultural pride and satisfaction can be identified- Ethnic and cultural inferiorityReligious- Offers satisfying spiritual experiences as well as contacts with an extra-familial support group- Rigid dogma/rituals
37 SCREEMEconomic- Economic stability is sufficient to provide both reasonable satisfaction with financial status and an ability to meet economic demands of normative life eventsEconomic deficiencyInappropriate economic planEducational- 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 comprehendMedical- 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
38 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.
39 DRAFTDRAFT 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.
40 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 agesSocial History- social background of each member regarding education, income, occupation, marital status, ethnicity, and cultureCommunity 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
41 II. Individual and Family Data Health historyFamily dynamics- dysfunction is often reflected in the health status of the family
42 Family MappingThis 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.
43 Family MappingA double line between two people indicates a functional relationship
44 A single line with a break in the middle indicates dysfunction
45 Three parallel lines between two people denotes an over-involved relationship where there is plenty of intrusion.
46 A solid line perpendicular to the relationship line symbolizes a rigid boundary where the rules are but non-negotiable
47 A broken line perpendicular to the relationship lines symbolizes a boundary that is clear but negotiable
48 A dotted line perpendicular to the relationship line signifies a boundary that is diffuse or unclear.
49 A bracket encompassing several people signifies the presence of a coalition or alliance between these people[ ]
50 An arrow pointing away from the system signifies escape from the system
51 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