This document discusses various tools that can be used to assess family structure and function in clinical practice. It describes family genograms which provide information on family members and relationships. Other tools include the Family Circle, Family APGAR, FACES, and FES questionnaires which evaluate factors like adaptation, cohesion, and environment. Additional methods like clinical biographies, SCREEM, DRAFT, and Family Mapping are explained as ways to assess family resources, pathology, and dynamics through drawings, timelines, and symbols. The document aims to help physicians understand families and identify dysfunctional patterns that may influence a patient's health or behavior.
2. Family Systems Medicine
The primary goal of
Family Systems
Medicine is to view the
patient’s problem in
multiple context
BY: ROMMEL LUIS C. ISRAEL III 2
3. Family Systems in Clinical
Practice
The family physician
must be able to
understand first the
basic concepts of
family structure and
function.
BY: ROMMEL LUIS C. ISRAEL III 3
4. 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
BY: ROMMEL LUIS C. ISRAEL III 4
5. 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
BY: ROMMEL LUIS C. ISRAEL III 5
6. 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
BY: ROMMEL LUIS C. ISRAEL III 6
7. 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
BY: ROMMEL LUIS C. ISRAEL III 7
8. 3. Family
Illness/History
This indicates the
presence of heredofamilial
diseases in which potential
problems in the family can
arise.
BY: ROMMEL LUIS C. ISRAEL III 8
10. 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
BY: ROMMEL LUIS C. ISRAEL III 10
11. 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.
BY: ROMMEL LUIS C. ISRAEL III 11
12. Dysfunctional Family
Defined as a family
with chronic inability
to respond to the
needs or to cope with
changes and stresses in
the environment
BY: ROMMEL LUIS C. ISRAEL III 12
13. 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.
BY: ROMMEL LUIS C. ISRAEL III 13
14. 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
BY: ROMMEL LUIS C. ISRAEL III 14
15. 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
BY: ROMMEL LUIS C. ISRAEL III 15
16. 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
BY: ROMMEL LUIS C. ISRAEL III 16
17. 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
BY: ROMMEL LUIS C. ISRAEL III 17
18. DELA CRUZ FAMILY
as of April 11, 2010
Project 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
BY: ROMMEL LUIS C. ISRAEL III 18
19. 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.
BY: ROMMEL LUIS C. ISRAEL III 19
21. 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.
BY: ROMMEL LUIS C. ISRAEL III 21
22. 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
BY: ROMMEL LUIS C. ISRAEL III 22
23. 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.
BY: ROMMEL LUIS C. ISRAEL III 23
24. FAMILY APGAR
QUESTIONNAIRE PART I
Helps define the
degree of the patient’s
satisfaction or
dissatisfaction with
family function
BY: ROMMEL LUIS C. ISRAEL III 24
25. Part I
Almost
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.
BY: ROMMEL LUIS C. ISRAEL III 25
26. Filipino Family APGAR Part I
Palagi(
2)
Paminsa
n-
minsan
(1)
Halos
hindi
(0)
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.
BY: ROMMEL LUIS C. ISRAEL III 26
27. 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
BY: ROMMEL LUIS C. ISRAEL III 27
28. Part II
Who lives in your home?
Name Relationship Age Sex
Well Fairly Poor
How do you get along?
BY: ROMMEL LUIS C. ISRAEL III 28
29. 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
BY: ROMMEL LUIS C. ISRAEL III 29
30. Family APGAR
Scoring:
8-10 points = highly functional
family
4-7 points = moderately
dysfunctional family
0-3 points = severely
dysfunctional family
BY: ROMMEL LUIS C. ISRAEL III 30
31. 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.
BY: ROMMEL LUIS C. ISRAEL III 31
32. 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.
BY: ROMMEL LUIS C. ISRAEL III 32
33. 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.
BY: ROMMEL LUIS C. ISRAEL III 33
34. 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.
BY: ROMMEL LUIS C. ISRAEL III 34
35. SCREEM
Resource 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
BY: ROMMEL LUIS C. ISRAEL III 35
36. 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
BY: ROMMEL LUIS C. ISRAEL III 36
37. 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.
BY: ROMMEL LUIS C. ISRAEL III 37
38. 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.
BY: ROMMEL LUIS C. ISRAEL III 38
39. 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
BY: ROMMEL LUIS C. ISRAEL III 39
40. II. Individual and Family Data
Health history
Family dynamics-
dysfunction is often
reflected in the health
status of the family
BY: ROMMEL LUIS C. ISRAEL III 40
41. 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.
BY: ROMMEL LUIS C. ISRAEL III 41
42. Family Mapping
A double line between two
people indicates a
functional relationship
BY: ROMMEL LUIS C. ISRAEL III 42
43. A single line with a
break in the middle
indicates dysfunction
BY: ROMMEL LUIS C. ISRAEL III 43
44. Three parallel lines between
two people denotes an over-
involved relationship where
there is plenty of intrusion.
BY: ROMMEL LUIS C. ISRAEL III 44
45. A solid line perpendicular to
the relationship line
symbolizes a rigid boundary
where the rules are but
non-negotiable
BY: ROMMEL LUIS C. ISRAEL III 45
46. A broken line perpendicular
to the relationship lines
symbolizes a boundary that
is clear but negotiable
BY: ROMMEL LUIS C. ISRAEL III 46
47. A dotted line perpendicular
to the relationship line
signifies a boundary that is
diffuse or unclear.
BY: ROMMEL LUIS C. ISRAEL III 47
48. A bracket encompassing
several people signifies the
presence of a coalition or
alliance between these
people
BY: ROMMEL LUIS C. ISRAEL III 48
49. An arrow pointing
away from the system
signifies escape from
the system
BY: ROMMEL LUIS C. ISRAEL III 49
50. 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
BY: ROMMEL LUIS C. ISRAEL III 50