1. Family Assessment Tools
Belmonte, Lee
Bulatao, Jose
Cheng, Monina

2. Patient and the Family
Patient with a health problem cannot be fully understood by considering only the pathophysiology of a medical problem
Better health care results if family relationships, family social & cultural systems are all considered
Family systems approach to patient care will require understanding of the family structure & function

3. I. Recognize Family Structure
Names, place of residence, specific roles, stage of the family in the family life cycle, and significant dates in the family
Use Family Genogram:
Family tree
Functional Chart
Family Illness/history

4. I II III IV # + # Pascual Family As of December 2009
Leoncio
Guillerma, 70
Cricencio 67
Jacinta #
Germany Leoncio,Jr Claudia Perlita Cristoto Lina Lisa Tita Arlene Alberta + #
Jose, 45
Ene Villa 40
Venerando 46
Arlene 36
Pascual Family
As of December 2009
9031 P. Noval St. Sampaloc + +
Ricky Ville 19
Reynan 17
Jeramay 6
Venerando Jr. 4
Functional charting: close / ≡overly close / distant / ^^^ conflictual.
+ = PTB; # heart disease

5. Family Tree
Must consist of 3 or more generations and each generation identified by Roman numerals
First born must be at the farthest left and siblings following to the right in order of birth
Family name placed above each family unit
Given names and age are placed below each symbol
Index patient – indicated by an arrow
Date is indicated when the chart was developed so that ages can be adjusted.

6. Functional chart More dynamic image of the family
Shows relationship of members
Allows one to judge the totality of the family unit

7. Family Illness
Denotes presence of an inheritable disease or familial tendencies indicating potential problems in the family

8. II. Family Function: 5 basic function
Families provide support for each other
Families establish autonomy and independence for each person in the system, which enhance personal growth of individuals within the family- roles to playwithin and outside the family
Families create rules that govern the conduct of the family and of the individuals within the family- interaction patterns, privacy, authority & decision making
Families adapt to change in the environment – 1st order change; 2nd order change
Families communicate with each other

9. Family function
Functional family: balance should be established between these functions Imbalance results from Overemphasis or under emphasis on the functions Communication Dysfunctional family: a family with chronic inability to respond to then needs of the members or to cope with changes and stresses in the environment

10. Smilkstein’s cycle of family function
Stressful life event in a family in equilibrium  in dysequilibrium:
Resources adequate – adaptation or coping is utilized to bring back into equilibrium
If resources are inadequate – crisis
Extrafamilial resources- if adequate then adaptation occurs but if still inadequate maladaptation in the family member (denial, repression, somatization projection)
Maladapted Family-
1. terminal dysequilibrium disintegrates
2. pathologic equilibrium  interaction is impaired due to unresolve crisis (depression, isolation, delinquency, school failure, running away from home

11. Family Assessment Instruments

12. Family Genogram

13. Family Circle

14. Family APGAR
Adaptation- capability of the family to utilize and share inherent resources.
Partnership- sharing of decision-making.
Growth- both physical and emotional growth
Affection- how emotions are shared between members
Resolve- how time, space, money are shared

15. FACES (Family Adaptibility and Cohesion Evaluation Scale
Is a self-reported scale wherein the patient rates his or her family on 30 items on a 1 to 5 scale

16. Family Environmental Scale (FES)
used to measure the social-environmental characteristics of family
The scale is a 90-item inventory that has a 10 subscales measuring
interpersonal Relationship dimension
Personal Growth
System Maintenance

17. Family Environmental Scale (FES)
Relationship dimension includes measurements of cohesion, expressiveness, and conflict
Five subscales refer to Personal Growth: independence, achievement orientation, intellectual-cultural orientation, active- recreational orientation, and moral-religious emphasis
System Maintenance measure how much planning is put into family activities and responsibilities and how much set rules and procedures are used to run family life

18. Family Environmental Scale (FES)
In addition, three separate forms of the FES are used to measure perception of the family
Real Form (Form R):people's attitude about their family current environment
Ideal Form (Form I): person's ideal family perception
Expectations Form (Form E): assess the family ability to withstand change

19. Clinical Biographies and life chart
Facilitate in the analysis of connection between a person’s experiences of health and illness
Help show the correlation between the life events and clinical events

20. SCREEM
Very important in the assessment of the family as to its capacity to participate in the provision of health care or to cope with crisis
Social, Cultural, Religious, Economic, Educational, Medical

21. resources pathology Social
Social interaction is evident among family members. Family have a well balanced lines of communication with extra familial social groups such as friends, sports, clubs, and other community groups
Isolated from extra familial
Problem of over commitment
Culture
Cultural pride or satisfaction can be identified, especially in distinct ethnic groups
Ethnic/cultural inferiority
Religious
Religion offers satisfying spiritual experiences as well as contacts with an extra familial support group
Rigid dogma rituals
Economic
Economic stability is sufficient to provide both reasonable satisfaction with financial status and an ability to meet economic demands of normative life events
Economic deficiency
Inappropriate economic plan
Educational
Education of family members is adequate to allow members to solve or comprehend most of the problems that arise within the format of the lifestyle established by the family
Handicapped to comprehend
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 or resources

22. Draw-a-family test (D.R.A.F.T.)
Projective technique that can be administered individually or in-group test
Provide clues on individual family member’s personalities and works as a diagnostic device
Does not measure the inherent ability to draw but how he pictures his family members

23. Draw-a-family test (D.R.A.F.T.)
Projective drawing like D.R.A.F.T. has been found to be useful and revealing because:
Patients exhibiting evasiveness and guardedness seem more likely to reveal their underlying traits and psychodynamics in the drawing because subjects are more intellectually aware of what they might expose through verbal communications
Drawing can be an expression of the unconscious label that represents an adultered basic needs
Drawings are first to show incipient psychopathology and the last to lose signs of illness after the patient recovers

24. Family Mapping
Facilitates the communication of informations about a family system to colleagues so that they can be understood

25. Family Mapping functional dysfunction
Over involved relationship where there is plenty of intrusion
Rigid boundary where the rules are clear but non negotiable
_ _ _ _ _ _ _
Boundary that is clear but negotiable
Boundary that is diffuse or unclear
[ ]
presence or coalition or alliance between several people
Pointing away from the system= escape from the system
Open end embracing 2 individuals and the pointed end pointing to a third signifies that the third person is being triangulated by the conflict between the other 2