FAMILY

ASSESSMENT
Ryan Jeanne v. Ceralvo, MD, DFM
TOOLS
Philippine Academy of Family Physicians
Orientation Course
September 26, 2014

Family Assessment Tools

Outline:
1.Family

Genogram
2.Family Map
3.Family APGAR
4.SCREEM
5.SCREEM-RES
6.Family Lifeline
7.Family life cycle
8.Ecomap

 9.

FACES ( Family Adaptability and

Cohesion Evaluation Scale
10. FES (Family Environmental Scale)
11. Clinical biography and life events

 Other

tools:
1.DRAFT (Draw-a-family test)
2.The family circle

Family Genogram
Provides

a quick overview of the family

members and relationships
A way to visually overlay biomedical and
psychosocial information
A study tool for gaining a
comprehensive understanding of
multigenerational family systems

Family Genogram
Symbol

care

of the Family Medicine-type of

Family Genogram
1.the names and ages of all family
members
2.The exact dates of birth, marriage,
separation, divorce, death (including
cause), and other significant life events
3.information covering 3 or more
generations
Illnesses (including hereditary and
significant problems or illnesses)

Family Genogram
5.the firstborn of each family to the left
with other siblings sequentially to the
right
6.indication of which members live
together in the same household
7.the names of 2 families with the
address of the index family
8.the informant/s
9.the date the genogram was generated

Standard Genogram Symbols

Family Map
A

tool designed to reflect family

relationships and interaction patterns
This tool is very important for the
physician in obtaining a therapeutic ally
for the delivery of care in the family
Provides a schematic description on
whom to ask for assistance in making
decisions for the patient

 The

possible source of the somatic

complaint may also be identified based
on the mapping of family relationships

Standard Family Map Symbols

Family APGAR
A

tool that qualitatively measures family

functioning
Limitations: data obtained is restricted
to what the patient is willing to disclose
about himself/herself and his/her family
The tool measures the patients
satisfaction with his familys functioning
but not the family functioning itself

Components of APGAR
Adaptation

It is the familys utilization of the

resources available within and outside
the familial system when significant
life events pose a crisis

Partnership

It is the sharing of the family members in

decision-making and responsibilities

Growth

It is the physical and emotional growth

attained by each family member from the
familys ability to support and guide

Affection

It is the loving or caring relationship of the

family

Resolve

It is the commitment of family members to

devote time to support each others
physical and emotional growth. It also
pertains to the sharing of wealth and space

Uses of Family APGAR

1.symptoms

that manifest themselves

as psychosomatic disorder such as,
frequent headaches, anxiety,
depression, insomnia, fatigue, and
increased pediatric complaints
2.difficult patients
3.marital or sexual difficulties
4.multiple presentations by multiple
family members

 5.drug

or alcohol abuse
6.evidence of sexual and physical abuse
on the wife or a child
7.multiple presentations of a family
member the thick file syndrome

Family APGAR Scoring

0-3

severely dysfunctional
4-7 moderately dysfunctional
8-10 highly functional

Family APGAR Part 1

Almost
always
Palagi
1

Some of the
time
Paminsanminsan
2

Family APGAR Part I

I am satisfied that I can turn to my

family for help when something is
troubling me
Akoy nasisiyahan dahil nakakaasa
ako ng tulong mula sa aking
pamilya sa oras ng
pangangailangan

I am satisfied with the way my

family talks over things with me
and shares problems with me
Akoy nasisiyahan sa paraang
nakikipagtalakayan sa akin ang
aking pamilya tungkol sa aking mga
problema

Hardly
ever
Halos
hindi
3

Family APGAR Part I

Almost always
Palagi
1

I am satisfied that my family

accepts and supports my wishes
to take on new activities or
directions
Akoy nasisiyahan at ang aking
pamilya ay tinatanggap at
sinusuportahan ang aking mga
nais na gawin patungo sa mga
bagong landas para sa aking
ikauunlad

I am satisfied with the way my

family expresses affection and
responds to my emotions such
as anger, sorrow, and love.
Akoy nasisiyahan sa paraang
ipinadadama ng aking pamilya
ang kanilang pagmamahal at

Some of the time

Paminsan-minsan
2

Hardly ever
Halos hindi
3

Family APGAR Part 1

Almost
always
Palagi
1

I am satisfied with
the way my family
and I share time
together
Akoy nasisiyahan
na ang aking
pamilya at ako ay
nagkakaroon ng
panahon sa isat isa

Some of the time Hardly

Paminsanever
minsan
Halos
2
hindi
3

Family APGAR Part 2

Who

lives in your home?

Sino-sino ang nakatira sa inyong
tahanan?

Name and
Age
Relationship
Edad
Pangalan at Relasyon

Sex
Kasarian

Family APGAR Part 2

How

do you get along?

Paano ang inyong relasyon?

Well
Mabuti

Fairly
Hindi
gaanong
mabuti

Poor
Hindi mabuti

Family APGAR Part 2

If

you dont live with your family, list the

persons to whom you turn to for help
Kung hindi ka nakakahingi ng tulong sa
iyong sariling pamilya, kani-kanino ka
humihingi ng tulong?

Name and Relationship

Pangalan at relasyon

Age
Edad

Sex
Kasaria
n

Family APGAR Part 2

How

do you get along?

Paano ang inyong relasyon?

Well
Mabuti

Fairly
Hindi gaanong
mabuti

Poor
Hindi
mabuti

Family SCREEM
Is

an acronym that represents family

resources
It is a tool where the family physician
helps the family members identify and
assess their resources to meet a crisis.
However, the lack of resources can also
serve as a kind of pathology in certain
situations

 Commonly

used when the need for care

is long or lasts a lifetime such as in the
case of chronically-ill, terminally-ill, and
hospice care
It can also be used to assess the
resources of difficult and non-compliant
patients

 Conclusions

are drawn from the

responses of the patient or family
members to different categories of
questions

Family SCREEM
Resources

Pathology

Social
The family is socially isolated
Social interaction is evident
from extra-familial groups
among family members. Family
members have well-balanced
lines of communication with
extra-familial social groups
such as friends, sports groups,
clubs, and other community
organizations

Cultural
Cultural pride or satisfaction
can be identified, especially in
distinct ethnic groups

The family has feelings of

cultural-ethnic inferiority or
shame

Family SCREEM
Resources

Pathology

Religious
Religion offers satisfying
spiritual experiences as well as
contacts with an extra-familial
support group

Dogma and rituals are so rigid

that they limit the familys
problem-solving capacity

Economic
Economic stability is sufficient
to provide both a reasonable
satisfaction with financial
status and and an ability to
meet the economic demands of
normal life events and illness

Financial problems make it

difficult for the family to meet
monetary demands of crisis or
illness

Family SCREEM
Resources

Pathology

Educational
Education of the 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

Handicaps limit the ability of family

members to comprehend the problem
or recommended solutions

Medical
Medical care is available through
channels that are easily established
and have previously been experienced
satisfactorily

A family has not established lines of

medical care or is unable to use health
care facilities due to problems such as
unwillingness to seek care, inadequate
finances, absence of transportation,
etc.

SCREEM Family Resource Survey

(SCREEM-RES)
This

is a 12-item self-administered
family resources questionnaire in Filipino
based on SCREEM
It is appropriate in assessing the
familys capacity to participate in the
provision of health care or to cope with
crisis

SCREEM-RES

SCREEM-RES Scoring
0-6

severely inadequate family

resources
7-12 moderately inadequate
13-18 adequate

Family Lifeline
It

is a tool that summarizes the history

of the family, particularly the individual
or the familys significant experiences
over a period of time in a
chronologically-sequenced manner
It also includes how the family has
coped with these stressful life events

Family Lifeline
The

presentation of a familys life events

in a limited space allows for a quick
retrieval of information that identifies
the factors that may affect the health of
the family

Family Lifeline
Useful

when anticipating a long-term

illness, the presence of difficult
caregiving, non-adherence to treatment
strategies, and in situations where the
doctor needs to think family

Family Lifeline
Useful

in abnormal behavior in a child,

inappropriate behavior in the antenatal
and/or post-partum period, drug or
alcohol abuse, and evidence of sexual or
physical abuse

Family Lifeline
The

interpretation is based on the most

significant event that probably affected
the health of each member or
influenced the health-seeking behavior
or perception on health of the individual
or the family

Family Lifeline
Knowledge

of these factors by health

care providers promotes better health
care provision and delivery

Family Life Cycle

Description

of the family dynamics

through clearly defined stages of
development

Other Tools
DRAFT

(Draw-a-family test)
The patient is asked to draw members
of his/her family
Provides clues on the significant
psychological issues within the family
system

 The

Family Circle
The family physician draws a large circle
on a piece of paper that represents the
family
The patient is asked to draw variablesized circles within or outside the big
circle that either touch each other or are
far apart

 These

figures represent the patient and

other significant persons
The patient will then explain the
diagram that he/she made

The Family Circle

Levels of Family
Involvement
These

levels are dependent on how

deep the physicians want, as health
care providers, to be involved in their
patients family
In our setting, it is best to be at least at
Level III

Levels of Family
Involvement
Level I

Minimal empahsis on the family

in the delivery of health care

Level II

Ongoing medical information and

advice. Works collaboratively with
patients and families, and
understands the triangular nature
of the patient-doctor-family
relationship

Level III

Feelings and support. The physician

understands normal family
development and how families
react to stress

Level IV

Assessment of family dysfunction

and provision of intervention. It is
the most common involvement
among patients who are alcohol or
drug abusers

Level V

Family therapy

love my family
And
I love Family Medicine as my Specialty!

 Thank

you!