Tools in Family Assessment

JI Veridiano,Ofelia S.
 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.
 Family Systems Medicine
• The primary goal of Family Systems
Medicine is to view the patient’s problem
in multiple context
Family Systems in Clinical Practice
• The family physician must be able to
understand first the basic concepts of
family structure and function.
 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
 Family Genogram
1. 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
• 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
 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
 3. Family Illness/History
• This indicates the presence of
heredofamilial diseases in which
potential problems in the family can
arise.
 Step 2
• Understand the normal family function
 5 Basic Family Functions
1. Provide support to each other
2. Establish autonomy and independence
for each person in the system
3. Create rules that govern the conduct of
the family and its members
4. Adapt to change in the environment
5. Communicate with each other
 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.
 Dysfunctional Family
• Defined as a family with chronic inability to
respond to the needs or to cope with
changes and stresses in the environment
 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.
 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
 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
 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
 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
 Veridiano Family
as of April 11, 2010
Project 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 Chok 36 ♦ 2005 Tere 38
♥ Hypertension
♦ Bronchial Asthma
Ja 4 ♦
 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.
 Family Circle

Dex

Mama Pesh Mama

chuchi

Arra
Rihanne
Me

Ja Kuya
Nel
Chok

Erin Ate
Tere
 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.
 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
 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.
FAMILY APGAR QUESTIONNAIRE
PART I
• Helps define the degree of the patient’s
satisfaction or dissatisfaction with family
function
 Part I
Almost Some of Hardly
always the time ever
(2) (1) (0)
I am satisfied that I can turn to my family for
A help when something is troubling me.

I am satisfied with the way my family talks

P about things with me and shares problems
with me.
I am satisfied that my family accepts and
G supports my wishes to take on new
activities or directions.
I am satisfied with the way my family
A expresses affection and responds to my
emotions such as anger, sorrow, and love.
I am satisfied with the way my family and I
R share time together.
 Filipino Family APGAR Part I
Palagi( Paminsa Halos
2) n- hindi
minsan (0)
(1)
A Ako’y nasisiyahan dahil nakakaasa ako ng tulong
sa aking pamilya sa oras ng problema.

P Ako’y nasisiyahan sa paraang

nakikipagtalakayan sa akin ang aking pamilya
tungkol sa aking problema.
G Ako’y nasisiyahan at ang aking pamilya ay
tinatanggap at sinusuportahan ang aking mga
nais na gawin patungo sa mga bagong landas
para sa aking ikauunlad.
A Ako’y nasisiyahan sa paraang ipinadadama ng
aking pamilya ang kanilang pagmamahal at
nauunawaan ang aking damdamin katulad ng
galit, lungkot, at pag-ibig.
R Ako’y nasisiyahan na ang aking pamilya at ako
ay nagkakaroon ng panahon sa isa’t-isa.
 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
 Part II
• Who lives in your home?

Name Relationship Age Sex

How do you get along?

Well Fairly Poor

 Part II
• If you don’t live with your Name Relationship Age Sex
family, list down the persons
you turn to for help

Well Fairly Poor

• How do you get along?
 Family APGAR
• Scoring:
• 8-10 points = highly functional family
• 4-7 points = moderately dysfunctional
family
• 0-3 points = severely dysfunctional family
 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.
 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.
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.
 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.
 SCREEM
Resource Pathology

Social -Isolated from extra-familial

-social interaction is evident among family -Problem of over commitment
members
-Family members have well-balanced lines
of communication with extra-familial social
groups
Cultural - Ethnic and cultural inferiority
-cultural pride and satisfaction can be
identified

Religious - Rigid dogma/rituals

- Offers satisfying spiritual experiences as
well as contacts with an extra-familial
support group
 SCREEM
Economic -Economic deficiency
- Economic stability is sufficient to provide -Inappropriate economic plan
both reasonable satisfaction with financial
status and an ability to meet economic
demands of normative life events

Educational -handicapped to comprehend

- Education of members is adequate to
allow members to solve or comprehend
most problems that arise within the format
of the lifestyle established by the family

Medical - Not utilizing health care

- Medical health care is available through facilities/resources
channels that are easily established and
have previously been experienced in a
satisfactory manner
 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.
 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.
 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
II. Individual and Family Data
• Health history
• Family dynamics- dysfunction is often
reflected in the health status of the
family
 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.
 Family Mapping
• A double line between two people
indicates a functional relationship
• A single line with a break in the middle
indicates dysfunction
• Three parallel lines between two people
denotes an over-involved relationship
where there is plenty of intrusion.
• A solid line perpendicular to the
relationship line symbolizes a rigid
boundary where the rules are but non-
negotiable
• A broken line perpendicular to the
relationship lines symbolizes a boundary
that is clear but negotiable
• A dotted line perpendicular to the
relationship line signifies a boundary that
is diffuse or unclear.
• A bracket encompassing several people
signifies the presence of a coalition or
alliance between these people

[ ]
• An arrow pointing away from the system
signifies escape from the system
• An open ended arrow with its open end
embracing two individuals and the pointed
end pointing to a third signifies that the
third person is being triangulated by the
conflict between the other two
Thank You!