Tools in Family Assessment

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 family • It 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 family • A 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 numerals • The first born of each generation is farthest to the left with the following siblings going to the right according to order of birth • Family name is placed above each major family unit

7. Names and ages written below the symbol • Index patient is identified with an arrow • Date must be indicated when it was made to be able to adjust the ages over time

8. 2. Functional Chart • It 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.

10. Step 2 • Understand the normal family function

11. 5 Basic Family Functions • Provide support to each other • Establish autonomy and independence for each person in the system • Create rules that govern the conduct of the family and its members • Adapt to change in the environment • Communicate with each other

12. Functional Family • Defined as a family wherein a balance between these functions is achieved. Imbalances may result from over or under emphasis of these functions.

13. Dysfunctional Family • Defined as a family with chronic inability to respond to the needs or to cope with changes and stresses in the environment

14. Step 3 • Learn to assess Family Structure and Function in Clinical Practice • Family 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 Genogram • Family Circle • Family APGAR • FACES (Family Adaptability and Cohesion Evaluation Scale) • FES (Family Environmental Scale) • Clinical Biography and Life Events • SCREEM • DRAFT (Draw A Family Test) • Family Mapping

16. Family Genogram • A graphic representation of a family tree that displays detailed data about the relationships among individuals in a family • Allows the user to analyze hereditary patterns and psychological factors that punctuate these relationships

17. Family Genogram • Quickly identify and understand various patterns in the patient's family history which may have had an influence on the patient's current state of mind • Maps out relationships and traits that may otherwise be missed on a pedigree chart

18. Family Genogram • An 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 member • Divisions of an extended family into several households • Medical problems and chronic illnesses of each family member • Significant dates in the family history • Nature of the family relationships

19. Veridiano Familyas of April 11, 2010Project 4, Quezon City 1943 1947 Constantino, 64 2006 ■ Mila Fatima 47 1994 ∆ 1967 1964 1968 1970 1965 1982 2007 Thess 42 ♥ Nel 45 May 39 ♦ Jojo 44 ♥ 1973 1971 Peng 27 ♥ • ∆ Ruptured aneurysm • ■ Heart failure • ♥ Hypertension • ♦ Bronchial Asthma Chok 36 ♦ 2005 Tere 38 Ja 4 ♦

20. Family Circle • Family 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. Dex Mama Pesh Mama chuchi Arra Rihanne Me Ja Kuya Nel Chok Erin Ate Tere Family Circle

22. Family APGAR • This 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 APGAR • Adaptation- the ability of a family to use and share inherent resources which can be either intra- or extra-familial • Partnership- the sharing of decision making which measures the satisfaction of solving problems through communicating • Growth- pertains to both physical and emotional aspects and measures the satisfaction of the freedom to change • Affection- emotions that are shared with and between family members which measures the satisfaction with the intimacy and emotional interaction that exist in the family • Resolve- refers to how time, money, and space are shared; this measures the satisfaction with the commitment made by members of the family

24. Family APGAR There 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 function • When 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 I

27. Filipino Family APGAR Part I

28. Family APGAR Part II • Delineates 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? How do you get along?

30. Part II • If you don’t live with your family, list down the persons you turn to for help • How do you get along?

31. Family APGAR • Scoring: • 8-10 points = highly functional family • 4-7 points = moderately dysfunctional family • 0-3 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. SCREEM • An 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

37. SCREEM

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. DRAFT • DRAFT 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 ages • Social History- social background of each member regarding education, income, occupation, marital status, ethnicity, and culture • Community 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 history • Family dynamics- dysfunction is often reflected in the health status of the family

42. Family Mapping • This 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 Mapping • A 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