Tools for Family Assessment

Dr. Nur Afrainin Syah, M.Med.Ed, PhD

With Courtesy toProf. Zorayda E. Leopando

• How many of you are physicians of families with several generations?• How do you assess families in terms of health?• What tools do you use?

Diagnostic tools

Individual Patients

Newborn APGARNewborn screening

Child Growth and Development Chart

Pregnant Mother Prenatal check upFundus heightDopplerLaboratory exams

Diagnostic tools

Families FunctionRelationshipStructure

Community Health indicatorsRates and ratiosEpidemiologic investigation

Family Oriented Primary Care

• Learning to “think family”• The importance of genogram• The family within a larger system – use an eco-map• Chronic illness and disability – supporting family caregivers• Working with family members – the family conference• Identifying the family at risk

FAMILY ASSESSMENT

• is the process of collecting data about the family structure, and the relationships and interactions among individual members.

• It is a continuous process.• It’s aim is to generate diagnoses with goals and interventions for care

created in collaboration with the family and caregivers.

Tools for Family Assessment

1. Genogram2. Family Apgar3. Eco-map4. SCREEM5. Family Lifeline6. Family Circle

1. Family Genogram

• A graphic representation of a family tree that displays detailed data about the relationships among individuals in a family over a period of time, usually three generations.

• Allows the user to analyze hereditary patterns and psychological factors that punctuate these relationships

Components of Family Genogram:

Family Tree Family names; three generations; names and age of all members; significant dates;

Family background on health Illnesses; causes of deaths

Social and interactional influences Members living together; possible source of stress; relationship

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

Genogram

Veridiano Familyas of April 11, 2010Project 4, Quezon City

1943 1947

Constantino, 64 2006 ■ Mila Fatima 47 1994 ∆

∆ Ruptured aneurysm■ Heart failure♥ Hypertension♦ Bronchial Asthma

Thess 42 ♥ Nel 45 May 39 ♦ Jojo 44 ♥ 1973 1971 Peng 27 ♥

1967 1964 1968 1970 1965 1982

Chok 36 ♦ 2005 Tere 38

Ja 4 ♦

2007

Family Genogram: Uses

• Quick overview on the family members and relationship• A way to visually overlay biomedical and psychological information• A study tool for gaining a comprehensive understanding of

multigenerational family systems

2. 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 IAlmost always (2)

Some of the time

(1)

Hardly ever

(0)

A I am satisfied that I can turn to my family for help when something is troubling me.

P I am satisfied with the way my family talks about things with me and shares problems with me.

G I am satisfied that my family accepts and supports my wishes to take on new activities or directions.

A I am satisfied with the way my family expresses affection and responds to my emotions such as anger, sorrow, and love.

R I am satisfied with the way my family and I share time together.

Family APGAR

• Scoring: • 8-10 points = highly functional family• 4-7 points = moderately dysfunctional family• 0-3 points = severely dysfunctional family

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

Well Fairly Poor

How do you get along?

Part II

• If you don’t live with your family, list down the persons you turn to for help

• How do you get along?

Name Relationship Age Sex

Well Fairly Poor

3. Ecomap = Family Mapping

• The family within a larger system• Reflects relationships and interaction• Provides schematic description whom to ask for assistance in making

decision for patients• Identify possible source of somatic complaints

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

Ecomap

Ecomap

Ecomap

Ecomap

Ecomap

4. 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.

SCREEMResource Pathology

Social-social interaction is evident among family members-Family members have well-balanced lines of communication with extra-familial social groups

-Isolated from extra-familial-Problem of over commitment

Cultural-cultural pride and satisfaction can be identified

- Ethnic and cultural inferiority

Religious

- Offers satisfying spiritual experiences as well as contacts with an extra-familial support group

- Rigid dogma/rituals

SCREEM

Economic

- Economic stability is sufficient to provide both reasonable satisfaction with financial status and an ability to meet economic demands of normative life events

-Economic deficiency-Inappropriate economic plan

Educational

- 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

-handicapped to comprehend

Medical

- Medical health care is available through channels that are easily established and have previously been experienced in a satisfactory manner

- Not utilizing health care facilities/resources

5. Family Lifeline (Clinical Biographies / 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.

6. 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.

• Physicians draw a big circle• Ask patient to draw smaller circles within the big circle or outside. Each circle

represent significant people in his/her life. Distance and size vary according to degree of closeness and significance to the patient

• Difficulty of interpretation and standardization poses as a disadvantage.

Family Circle

Me

Mama Pesh Mama chuchi

Chok

Ja Kuya Nel

Dex

Arra

Erin Ate Tere

Rihanne

Actual Exercise Using the Tools

• Work in pairs, assess each other• Reflect on the experience by answering the following questions

• What did you feel?• Were you able to finish? Why yes and why not??• How will you teach the tools to your medical students??