DEPARTMENT OF PUBLIC HEALTH & PREVENTIVE MEDICINE

FACULTY OF MEDICINE, UNIVERSITAS PADJADJARAN

2013

FAMILY ASSESSMENT
TOOLS
LEARNING OBJECTIVES
Describe the advantages for assessing
family (C2)
Define the family genogram, family map,
family APGAR and its function (C2)


Why do we Need tools to Assess the family?

assess family functioning
assess family dynamic
assess coping mechanisms
of the family
assess resources
assess family structure

to have a picture of the multigenerational
patterns of behavior or illnesses.
to assess the normal crisis or common
illness to be encountered in each stage of
development.
to provide anticipatory care and guidance.

Why do we Need tools to Assess the family?

An understanding of the family in terms of the
struggles to be functional will enable FP to make
correct diagnosis and intervention

FAMILY DYNAMICS
An interactions and
relationships among
the individual
members of a family
Reflects and
influence the
physical, mental and
spiritual health of the
individuals in a
family.
FAMILY DYNAMICS
An understanding of the dynamics helps the
attending family physician to diagnose the
disease and dis-ease in the patient sitting in
his consultation room and to recognize the
factors that may help or retard the recovery of
this patient.

FAMILY ASSESSMENT TOOLS
Anatomy
Genogram
Development
Family
life cycle
Function
APGAR
Family
Map
Lifeline
SCREEM
Impact
BATHE
GENOGRAM
Is a biopsychosocial family tree.
It records the family in its life cycle,
family illnesses and relationship
A genogram is a versatile clinical tool
that can help FP integrate a patients
family information into the medical
problem-solving process for better
patient care
A genogram supplements the problem list giving
FP an overview of the main problems affecting the
family over 3 or more generations
A genogram can be drawn in skeletal form during
one of the first few visits, ideally the first visit and
then it can elaborated during subsequent visits as
more is known about the family
GENOGRAM COMPONENTS
Symbols
Standardized Symbols used in Family Genograms
A
b
m
d
D
male
female
Sex not specified
Deceased/death
Adopted female
date of birth
date of marriage
date of divorce
Date of death
abortion or miscarriage
Pregnancy-child in utero
Dizygotic twins
Monozygotic Twins
Induced abortion
STANDARDIZED SYMBOLS USED IN FAMILY GENOGRAMS
Symbols of diseases or situation
Allergy
Alcoholism
Obesity
Asthma
Hypertension
xxx xxx




Heart disease
Stroke
Depression
War Casualty
COMMONLY USED ABBREVIATIONS
ALC
Alcoholic
ALL
Allergy
ARTH
Arthritis
CAD
Coronary Artery
Disease
CVA
Cerebrovascular
Accident
CA
Cancer
DEP
Depression
DM
Diabetes mellitus
GI
GI tract disease
HT
Hypertension
MI
Myocard Infarction
MVP
Mitral Valve Prolapse
PUD
Peptic Ulcer Disease
SLE
Systemic Lupus
Erythematosis
TB
Tuberculosis
STANDARDIZED SYMBOLS USED IN FAMILY GENOGRAMS
married and year
Divorce and year
Unmarried
relationship
Separation and
year
1989
1990
1992
Conflictual relationship
Distance relationship
Close relationship
1989
1989
1992
Family living together

I
II
III
Bakri, as of 8 April 2010
Ardi,68
Nia,64
1970
1969

1. Symbols
2. Three or more generations
3. The name of family
4. A listing of the first born of
each family to the left, with
siblings listed sequentially to
the right
5. The names of all family
member
6. Age or year of birth of all family members
7. Any deaths, incl. age of death and cause
8. Dates of marriages and divorces
9. Significant diseases or problems of family members
10. Indication of members living together in the same
household
11. A key depicting all symbols used
12. Symbols selected for simplicity and maximum visibility

FAMILY INFORMATION IS USED IN 3 TYPE
SITUATIONS:

1. Evaluating somatic complaint by testing
biopsychosocial hypotheses
2. Assessing a patients risk for biomedical and
mental disorders
3. Planning management by considering how
family factors may facilitate or complicate it
USES OF THE GENOGRAM
(CROUCH AND DAVIS, 1987)
Allowing the family physician and other health professional to
review quickly the family situation
Building rapport by using the first names of family members,
knowing who is living in the home
Identifying at a glance significant risk factors : Hypertension,
DM, Ca, Obesity etc
Recognizing the need for screening in patients who at high risk
Promoting lifestyle changes and health education (healthy
living)
Demonstrating that family relationship are a concern of the
family physician and important to the health of each family
member
This is a self-drawing by an 8 year
old girl who participated in a
support group for children
affected by domestic violence
sponsored by Cedar Valley
Friends of the Family.

One cannot escape sensing this
child's unhappiness; the frown she
drew on her little face clearly sets
the mood. However, the up-side-
down rainbow is perhaps the most
significant message... Generally,
we think of rainbows as a happy
reminder of hope for the future. In
this simple drawing, the little girl
innocently, but quite vividly


Relationship of the members
43
84
Sugeng
Ani

myoma
60
Utomo
58
Sri
DM
CA
Colon/Renal
54
Arti
FAM
84 1959
Putro
48 44
44
Tyio Tuti Nina
Lung Ca
46
Sam
Aria Imam
20 16
AMI
Genogram : 24 January 2008
FAMILY MAP
APGAR
This is a five-item questionnaire
designed to elicit the patients
perception of the current state of his
family relationships, and serves as a
rapid screening instrument for family
dysfunction.
APGAR
Adaptation is the capability of the family to utilize
and share inherent resources
Partnership is sharing of decision making. This
measures the satisfaction attained in solving
problems by communicating.
Growth refers to both and emotional growth. This
measures the satisfaction of the availability
freedom of change
APGAR
Affection is how emotions like love, anger and hatred are
shared between members. This measures the members
satisfaction with intimacy and emotional interaction that
exist in the family.
Resolve refers to how time, space and money are
shared. This measures the members satisfaction with
the commitment made by other members of the family.

8-10 point (Highly functional family)
4-7 point (Moderately dysfunctional family)
0-3 point (Severely dysfunctional family)

BATHE TECHNIQUES
(Stuart and Liebermans)
15 minutes method of
primary care counseling
It helps draw out the quiet
patient and provides a
structure of when to move on
in a talkative patient
B = Background
A = Affect
T = Troubling
H = Handling
E = Empathy
B = Background : assessing whats the
background situation (areas of psychological
problems)
How are things at home? At work?
Whats different in your life between now and before?

A = Affect = the patients affect (about common
areas generating strong feelings)
How do you feel about your home life?
How do you feel about your work/school?
T = Troubling: the problem that is most troubling for
the patient
What most worries you about your life?
How stressed are you by this problem?
What do you think this problem means to
you?

H = Handling: the manner in which the patient has
been handling the problem, problems are often
mishandled life difficulties
How are you handling the problems in your
life?
What have you tried to solve the difficulty?
How much support are you getting at
home/work?
Who gives you support for dealing with
problems?

E = Empathy : respons that conveys
empathy,express understanding of the patients
distress
I can understand that you would feel angry
That must have been difficult
This is a tough situation to be in

Thank you
1. Rakel RE. The Family Genogram. In Rakel RE.
Textbook of Family Practice. Sixth Edition. WB
Saunders Co. Philadelphia. 2002. pp 19 30.

2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine
Practice. Singapore, 2004. section 3 chapter 3 pp 58-
62