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.
The medical specialty that provides a continuing and
comprehensive health care for the individual and the family.
(Rakel, 1998, 2011)
To heal a patient, one has to understand his/her inner world – the
values he/she lives by; his thoughts, feelings, and fears, and
his/her perception of the illness and its effects on his life.
The management of illness requires a consideration of personal
and religious beliefs; social, economic or cultural problems;
personal feelings and expectations; and the patient’s family.
(There is a recognition of the effects of these factors on the
Relationship between families and their
physician is a powerful vehicle for
influencing patients about issues
regarding health and illness
Thus a good family assessment is needed
in order to promote a working alliance
Designed for family physicians to have a
systematic way of understanding the
family and to aid them in evaluating the
impact of illness on a person and on
his/her role in the family.
Recognize the Family Structure
Know the individual members of the
A systematic way of obtaining and
recording this information is through the
use of a Family Genogram
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
Defined as a family wherein a balance
between these functions is achieved.
Imbalances may result from over or
under emphasis of these functions.
Defined as a family with chronic inability
to respond to the needs or to cope with
changes and stresses in the environment
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 Life Cycle
SCREEM Family Resource Survey
Family Life Cycle
Can be used to gather data about an individual,
couple or family, especially on inheritance patterns,
family illnesses, family members, family structures and
emotional processes over time.
It is a compulsory part of the patient’s chart because
› A way to visually overlay biomedical and psychosocial
› Quick overview of the family members and relationship.
› A study tool for gaining a comprehensive understanding
of mutigenerational family systems (pineda, 1999).
1. Family Tree
Must consist of 3 or more generations
with each generation identified by Roman
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
Names and ages written below the
Index patient is identified with an arrow
Date must be indicated when it was
made to be able to adjust the ages over
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
3. Family Illness/History
This indicates the presence of
heredofamilial diseases in which
potential problems in the family can
The names and ages of all family members
The exact dates of births, marriage, separation, divorce, death and
other significant life events.
Information covering 3 or more generations
The firstborn of each family to the left with other siblings sequentially
to the right.
Indication of which members live together in the same household.
The names of 2 families with the address of the index family
Significant Dates and date the Genogram was generated
A tool designed to reflect family
relationships and interaction patterns.
This application is use for the
communication of information about the
family system and its dynamics in order to
address psychosocial issues.
It also provides a schematic description on
whom to ask for assistance in making
decisions for the patient.
ENMESHMENT – one has to
explore whether family
members seldom act
independently or get over
involved with each other.
DISENGAGEMENT – one
has to explore whether
family members are
isolated from each other
or have little emotional
response from each other.
TRIANGULATION – one has
to explore whether the
family member talks
directly to each other
about personal matters.
COALITION – one has to
explore whether one
member of the family is
siding with another
It is a tool that qualitatively measures family
It is a 10 to15-minute paper and pencil
technique that elicits the patient’s
perception and level of satisfaction on the
current state of her family member’s
relationships (Smilkstein, 1978)
This is a 5 item questionnaire designed to
elicit the patient’s perception of the
current state of his family relationships and
which serve as a rapid screening instrument
for family dysfunction.
A Adaptation The capability of the family to utilize and
share inherent resources.
P Partnership Measures the satisfaction attained in
solving problems by communication.
G Growth Refers to the freedom of change both
physical and emotional growth.
A Affection It is the intimacy and emotional interaction
in the family.
R Resolve The member’s satisfaction with the
commitment made by other members of
When the family will be directly involved in
caring for the patient.
When treating a new patient in order to
get info to serve as general view of family
When treating a patient whose family is in
When a patient’s behavior makes you
suspect a psychosocial problem possibly
due to family dysfunction.
Symptoms that manifest themselves as
Marital or sexual difficulties
Multiple presentations by multiple family
Drug or alcohol abuse
Evidence of sexual and physical abuse on
wife or a child
Multiple presentations of a family member –
”The thick file syndrome”
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.
Delineates relationships with other
members, identifies persons who can
give assistance to the patient, and
indicates conflicts not revealed in part I
Who Lives in your home? How do you get along?
Name Relationship Age Sex Well Fairly Poor
If you don’t live with your family, list the
persons to whom you turn to for help.
How do you get along?
Name Relationship Age Sex Well Fairly Poor
The data obtained is
restricted to what the
patient is willing to
himself/herself and his
The tool measures the
with his family’s
functioning but not the
family functioning itself
It is an acronym that represents family
resources and is a tool where the family
physician helps the family members
identify and assess their resources to
meet a crisis. If there is a lack of
resources, it can also serve as a kind of
pathology in certain situations.
Relationships of health behavior,
practices and utilization of health
services and barriers to patient care.
It is 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 patients.
It can also be used to assess resources of
difficult and non-compliant patients.
It is a 12 item self-administered family
resources questionnaire in Filipino based
It is a appropriate in assessing the
family’s capacity to participate in the
provision of health care or to cope with
crisis (Corales & Medina, 2011).
The format of the tool is user-friendly and
therefore, apt for a doctor in a busy
Family caregivers are asked to choose one of the
The interpretation of SCREEM-RES is similar to the
Family APGAR where the sum of the scores is
interpreted (Medina et al. 2011):
0-6 = means the family has severely inadequate family
7-12 = moderately inadequate family resources.
13-18 = adequate family resources
It is a tool that summarizes the history of the
family, particularly the individual or the
family’s significant experiences over a period
of time in a chronologically-sequenced
manner, and includes how the family has
coped with these stressful life events.
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.
Is used to show the family’s
significant events over a
period of time in a
It includes normative and
non normative crisis
It is sometimes placed side by
side with the illness history
It helps process how flexible a
family is when dealing with
This is a description of the family
dynamics through clearly defined stages
It provides a predictable and
chronological sequence of events in the
family’s life, which can be related to
clinical events and to the health
maintenance of family members.
STAGES TASKS TO BE ACHIEVED HEALTH IMPLICATIONS
Leaving Home (Unattached
-Establishing personal independence.
-Beginning emotional separation from parents.
Episodic medical problems
Newly Married Couple -Establishing an intimate relationship with spouse.
-Developing further the emotional separation from
Learning To Live Together -Dividing the various marital roles in an equitable
-Establishing a new, more independent
relationship with family
Family with Young Children
-Opening the family to include a new member.
-Dividing the parenting roles.
-Accidents and poisoning
Family with Adolescent Increasing the flexibility of the family boundaries
to allow the adolescent(s) to move in and out of
the family system.
-Drug and other substance abuse
-STDs and gynecological problems
Launching Family -Accepting the multitude of exits from and entries
into the family system.
-Adjusting to the ending of parenting roles.
Retirement -Adjusting to the ending of the wage-earning
-Developing new relationships with children,
grandchildren and each other.
Old Age -Dealing with lessening abilities and greater
dependence on others.
-Dealing with losses of friends, family members
and, eventually, each other.
It is a pictorial representation of a
family’s connections to persons and/or
systems in their environment.
It’s purpose is to support classification of
family needs and decision making about
potential interventions, and it is to create
shared awareness of the family’s
significant connections and the
constructive influences those
connections may be having.
It can illustrate 3 separate dimensions for
› IMPACT of the connection
› QUALITY of the connection
› STRENGTH of the connection
Enables a structured, consistent process for gathering
specific, valuable information related to the current
state of a family or individual being assessed.
Supports the engagement of the family in a dialogue.
Identifies and illustrates strengths that can built upon
and weaknesses that can be addressed.
Summarizes complex data and information into a visual,
easy to see and understand format to support
understanding and planning.
Illustrates the nature of connectedness and the impact
of interactions in pre-defined “domain” areas.
Provides a consistent base of information to inform and
support intervention decisions.
Allows objective evaluation of progress.
Helps support integration of the concept of family
assessment as an ongoing process.
Reduces narrative in other parts of the family
Integrates the values and concepts in a practical way.
At the center of the ecomap, a simplified view
of the target family members in the household
should be depicted, using Genogram symbols
The intent is for each individual in the
household to be addressed.
There are some domains that will, for some
families, apply at the household level, or for all
individuals in the family.
Each individual can be “brought out of the
center” into its own circle and then domains
that need to be addressed for the individual
If a family or an individual is so complex that the
ecomap becomes messy, you can illustrate any
individual or household on its own.
Illustrate the existence of a connection and
the strength of it.
Illustrate the impact of a connection, place
an arrow on the end of the line indicating
whether resources and energy are flowing
to a person or away from a person.
If a connection is stressful, illustrate with a
jagged line superimposed on the
Brief summary comments may be written
inside the domain circles.
Domains should be identified on the
Draft (Draw a Family Test)
The Family Circle
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.
Foundto 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
2.The unconscious label which represents
adultered basic needs can be expressed
3.Drawings are the first to show incipient
psychopathology and the last to lose the signs
of illness after patient recovery.
It tells a lot about the patient’s feelings,
relationships they have with people around,
self-esteem and intellectual problems.
a very informative method of getting to
know the patient especially when working
A brief, graphic method for disclosing,
gathering and discussing family dynamics
as discussed by one or more family
Are often used in individuals but they can
be applied to small groups
Through this tool one can assess openness,
boundaries, support, function, triangulation
and interdependence in the family
Difficulty of interpretation and
standardization poses as a disadvantage.
Mama Pesh Mama
Lastly, it is essential for family physician to
know how far they can go in assessing
family dynamics and their relation to
Doherty et al. (1999) created a model of
the five levels of involvement with
Level I: Minimal emphasis on the family in the
delivery of health care
Level II: Ongoing medical information and
Level III: Feelings and support.
Level IV: Assessment of family dysfunction and
provision of intervention.
Level V: Family Therapy.