TOOLS IN FAMILY

ASSESSMENT
1

 Patient

coming in to the clinic with health

problem cannot be fully understood if only
the pathophysiology of medical problem is
considered

Family

relationship + family social system

+ family cultural system = better evaluation
& better health care

Family

systems approach to common

clinical situation can facilitate a new level
2
of understanding of patients problem
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

STEPS IN INCORPORATING
FAMILY SYSTEMS APPROACH
INTO CLINICAL PRACTICE
STEP 1

RECOGNIZE FAMILY
STRUCTURE
3

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

RECOGNIZING FAMILY
STRUCTURE

know individuals in the family

names, place of residence, specific roles in the family,
stage of family in family life cycle, significant dates in
the family
complete a family genogram

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

FAMILY GENOGRAM
Very

excellent tool in learning about

family structure
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
5

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

FAMILY GENOGRAM

Graphic representation of following components of a

family:
1. Family Tree
2. Functional Chart
3. Family illness/History

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

GF

male

death

female

index patient

spontaneous abortion

marital discord &

A

pregnancy

adopted
2005

cause of death

marriage and year

separation & year

not married

conflictual relationship

distant relationship

close relationship

overly close

dominant relationship

marital discord 7

1968

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.46

FAMILY 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 over9
time
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36

FUNCTIONAL CHART
Gives a more dynamic image of family
Allows one to judge totality of family unit (strengths &
weaknesses, ability to withstand future stressful
situations)

10

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

FAMILY ILLNESS/HISTORY

Denotes presence of inherited diseases or familial

tendencies indicating potential problems in the
family

11

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

COLANSE

PIEDRA

I
Salvador,6
3
2000

Vicenta,5
2
1996

Ben,43
1942

Maria,7
8
2003

II
Bert
o
48

Celso
46

Jojo Monch Pepe

41
37
35

Gil Samuel
32
29

Erdul,4
4

III

Evelyn,4
9

Erlyn, 23 Cris, 25

cancer
allergy
cardiac pathology

Mayet, 22Bert,20

asthma

Nina,19 Don, 27

Informant: Lorna
Address: Paco, Manila
Colanse-Piedra
Family
May 6,2016
12

13

 STEP

UNDERSTANDING NORMAL
FAMILY FUNCTION

14

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.37

BASIC FAMILY FUNCTIONS

Provide support to each other
Establish autonomy & independence for each
person
Create rules governing conduct of family & of
individuals within the family
Adapt to change in environment
Communicate with each other

15

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.37

STEP 3

LEARN TO ASSESS FAMILY

STRUCTURE AND
FUNCTION IN CLINICAL
PRACTICE

16
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39

FAMILY ASSESSMENT
INSTRUMENTS
1.
2.
3.
4.
5.
6.

Family Genogram
Family Circle
Family Map
Family APGAR by Smilkstein
Clinical Biography and Life Events
SCREEM

17

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39

Family Circle
A graphic method
for disclosing dynamics
of family interaction
using circles.

18

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39

FAMILY CIRCLE

JULIUS
PAPA
NANANG

MAYET

M OMMY

MELVIN
BATZ
NINA

19

Taken from the Daffodil case presentation

20

FAMILY MAP

Developed by Salvador Minuchin (Psychiatrist-Family

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

21

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.50

functional relationship
dysfunction
over-involved relationship with plenty of
intrusion
negotiable

rigid boundary where rules are clear but nonclear boundary but negotiable
boundary that is diffuse or unclear
presence of coalition or alliance between these people
escape from the system
22
third person is triangulated by conflict between the
other 2
Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.50

Taken from the Daffodil case presentation

23

FAMILY APGAR
Rapid screening test instrument for family
dysfunction
Has adequate reliability and validity to measure
individuals level of satisfaction about family
relationships

24

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40

FAMILY APGAR

A
P
G
A
R

ADAPTATION
PARTNERSHIP
GROWTH
AFFECTION
RESOLVE
25

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40

 ADAPTATION

Capability of family to utilize & share inherent resources

(intra/extra-familial)

PARTNERSHIP

Sharing of decision-making; measures satisfaction attained in

solving problems by communicating

GROWTH

Physical & emotional growth; measures satisfaction of

available freedom to change

AFFECTION

How love, anger, hatred are shared between members;

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

RESOLVE

How time, money, space are shared; measures members

satisfaction with commitment by other members of family

26

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40

WHEN IS FAMILY APGAR

NEEDED?
1.
2.
3.
4.

When family is directly involved in caring for the

patient
When treating a new patient in order to serve as
general view of family function
When treating a patient whose family is in crisis
When patients behavior makes you suspect a
psychosocial problem possible due to family
dysfunction

27

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40

Parameters

ALMOST SOME OF HARDLY

ALWAYS
THE
EVER
TIME
Score =
Score =
2
Score =
0
1

I am satisfied that I can

turn my family for help
when something is
troubling me

I am satisfied with the way

my family talks on things
with me & shares
problems with me

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

I am satisfied with the way

my family expresses
affection & responds to
my emotion such as
28
anger, sorrowPineda,
& love
Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.41

SCORING:
8 10

HIGHLY FUNCTIONAL

4 7 MODERATELY DYSFUNCTIONAL
0 3 SEVERELY DYSFUNCTIONAL

29

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.41

CLINICAL BIOGRAPHY & LIFE

EVENTS

Valuable tools which can facilitate analysis of

connection
Individuals experiences with health and sickness are
connected with his personal life

30

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48

Example (taken from Daffodil case presentation)

1982
1983
1990
1992
1997
1999
2000
2001

- Childhood years
- Sibling Rivalry
- First love
- Financial Difficulties
- Sexually Violated
- Met Bobby Common-law relationship
- 2nd pregnancy
- 3rd pregnancy
- Resignation of Bobby
- Guest Relations Officer

2002 - New boyfriend 4th pregnancy

2004 - 5th pregnancy
- Reconciliation with Bobby
2005 - Financial problems
2006 - Vaginal bleeding
- Hospitalized Cervical Cancer

31

SCREEM

Important as to assess familys

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

32

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48

SCREEM

RESOURCE

SOCIAL
CULTURAL
RELIGIOUS
ECONOMIC

Social interaction is evident among family members.

Family members have well-balanced lines of
communication with extra-familial social groups.

EDUCATION
AL

Education of family members is adequate to allow

members to solve or comprehend most of the
problems that arise within the format of the life style
established by the family

MEDICAL

Health care is available through channels that are

easily established and have previously been
experienced in a satisfactory manner
33

Cultural pride or satisfaction can be identified,

especially in distinct ethnic groups.
Religion offers satisfying spiritual experiences as
well as contacts with an extra-familial support
group.
Economic stability is sufficient to provide both
reasonable satisfaction with financial status and an
ability to meet economic demands of normative life
events.

Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48