Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

12

Share

Download to read offline

33010802 tools-for-family-assessment

Download to read offline

Related Books

Free with a 30 day trial from Scribd

See all

33010802 tools-for-family-assessment

  1. 1. TOOLS IN FAMILYTOOLS IN FAMILY ASSESSMENTASSESSMENT
  2. 2.  Patient coming in to the clinic with healthPatient coming in to the clinic with health problemproblem cannot be fully understoodcannot be fully understood if only theif only the pathophysiology of medical problem ispathophysiology of medical problem is consideredconsidered  Family relationship + family social system +Family relationship + family social system + family cultural system = better evaluation &family cultural system = better evaluation & better health carebetter health care  Family systemsFamily systems approach toapproach to common clinicalcommon clinical situation can facilitate a new levelsituation can facilitate a new level ofof understanding of patient’s problemunderstanding of patient’s problem Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  3. 3. Steps in Incorporating FamilySteps in Incorporating Family Systems Approach intoSystems Approach into Clinical PracticeClinical Practice  STEP 1STEP 1 RECOGNIZE FAMILYRECOGNIZE FAMILY STRUCTURESTRUCTURE Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  4. 4. RECOGNIZING FAMILYRECOGNIZING FAMILY STRUCTURESTRUCTURE  know individuals in the familyknow individuals in the family  names, place of residence, specific rolesnames, place of residence, specific roles in the family, stage of family in family lifein the family, stage of family in family life cycle, significant dates in the familycycle, significant dates in the family  complete a family genogramcomplete a family genogram Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  5. 5. FAMILY GENOGRAMFAMILY GENOGRAM  Very excellent tool in learning about familyVery excellent tool in learning about family structurestructure  Records names and roles of each member ofRecords names and roles of each member of the familythe family  Separates extended family into severalSeparates extended family into several householdhousehold  Documents medical problems of each memberDocuments medical problems of each member of the familyof the family  Documents significant dates in the family historyDocuments significant dates in the family history Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  6. 6. FAMILY GENOGRAMFAMILY GENOGRAM  Graphic representation of followingGraphic representation of following components of a family:components of a family: 1. Family Tree1. Family Tree 2. Functional Chart2. Functional Chart 3. Family illness/History3. Family illness/History Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  7. 7. malemale deathdeath femalefemale index patientindex patient spontaneous abortionspontaneous abortion marital discord & GFmarital discord & GF pregnancypregnancy adoptedadopted cause of deathcause of death marriage and yearmarriage and year separation & yearseparation & year not marriednot married conflictual relationshipconflictual relationship distant relationshipdistant relationship close relationshipclose relationship overly closeoverly close dominant relationshipdominant relationship marital discordmarital discord A 2005 1968 Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.46
  8. 8. FAMILY TREEFAMILY TREE  Must contain 3 or more generations, each identified by a Roman numeral  1st born of each generation is farthest to left, with siblings following to right in order of birth  Family name placed above each major family unit  Given names and ages are placed below each symbol  One member of family is of greater medical significance because of an illness (index patient, identified with an arrow)  Date is indicated when chart was developed so ages would be adjusted over time Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  9. 9. FUNCTIONAL CHARTFUNCTIONAL CHART  Gives a moreGives a more dynamic imagedynamic image of familyof family  Allows one to judge totality of family unitAllows one to judge totality of family unit (strengths & weaknesses, ability to(strengths & weaknesses, ability to withstand future stressful situations)withstand future stressful situations) Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  10. 10. FAMILYFAMILY ILLNESS/HISTORYILLNESS/HISTORY  Denotes presence of inherited diseases orDenotes presence of inherited diseases or familial tendencies indicating potentialfamilial tendencies indicating potential problems in the familyproblems in the family Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.36
  11. 11. Ben,43 1942 Maria,7 8 2003 Salvador,6 3 2000 Vicenta,5 2 1996 COLANSE PIEDRA Berto 48 Celso 46 Erdul,4 4 Jojo 41 Monch 37 Pepe 35 Gil 32 Samuel 29 Evelyn,49 Erlyn, 23 Mayet, 22 Nina,19 I II III cancer allergy cardiac pathology asthma Colanse-Piedra FamilyColanse-Piedra Family June 28,2008June 28,2008 ↑ Cris, 25 Bert,20 Don, 27
  12. 12.  STEP 2STEP 2 UNDERSTANDINGUNDERSTANDING NORMAL FAMILYNORMAL FAMILY FUNCTIONFUNCTION Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.37
  13. 13. Basic Family FunctionsBasic Family Functions Provide support to each otherProvide support to each other Establish autonomy & independence for eachEstablish autonomy & independence for each personperson Create rules governing conduct of family & ofCreate rules governing conduct of family & of individuals within the familyindividuals within the family Adapt to change in environmentAdapt to change in environment Communicate with each otherCommunicate with each other Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.37
  14. 14.  STEP 3STEP 3 LEARNLEARN TO ASSESSTO ASSESS FAMILYFAMILY STRUCSTRUCTURE ANDTURE AND FUFUNCTIONNCTION ININ CLINICALCLINICAL PRACPRACTICETICE Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39
  15. 15. FAMILY ASSESSMENTFAMILY ASSESSMENT INSTRUMENTSINSTRUMENTS 1.1. Family GenogramFamily Genogram 2.2. Family CircleFamily Circle 3.3. Family MapFamily Map 4.4. Family APGAR by SmilksteinFamily APGAR by Smilkstein 5.5. Clinical Biography and Life EventsClinical Biography and Life Events 6.6. SCREEMSCREEM Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39
  16. 16. Family Circle A graphic method for disclosing dynamics of family interaction using circles. Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.39
  17. 17. FAMILY CIRCLEFAMILY CIRCLE M OMMY PAPA MELVIN NINA BATZ NANANG JULIUS MAYET
  18. 18. Taken from the “Daffodil” case presentation
  19. 19. FAMILY MAPFAMILY MAP  Developed by Salvador MinuchinDeveloped by Salvador Minuchin (Psychiatrist-Family therapist)(Psychiatrist-Family therapist)  Facilitates communication of informationFacilitates communication of information about a family system to colleagues soabout a family system to colleagues so that they can be understoodthat they can be understood Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.50
  20. 20. functional relationshipfunctional relationship dysfunctiondysfunction over-involved relationship with plenty ofover-involved relationship with plenty of intrusionintrusion rigid boundary where rules are clear but non-negotiablerigid boundary where rules are clear but non-negotiable clear boundary but negotiableclear boundary but negotiable boundary that is diffuse or unclearboundary that is diffuse or unclear presence of coalition or alliance between these peoplepresence of coalition or alliance between these people escape from the systemescape from the system third person is triangulated by conflict between thethird person is triangulated by conflict between the other 2other 2 Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.50
  21. 21. Taken from the “Daffodil” case presentation
  22. 22. FAMILY APGARFAMILY APGAR  Rapid screening test instrument for familyRapid screening test instrument for family dysfunctiondysfunction  Has adequate reliability and validity toHas adequate reliability and validity to measure individual’s level of satisfactionmeasure individual’s level of satisfaction about family relationshipsabout family relationships Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40
  23. 23. FAMILY APGARFAMILY APGAR  AA ADAPTATIONADAPTATION  PP PARTNERSHIPPARTNERSHIP  GG GROWTHGROWTH  AA AFFECTIONAFFECTION  RR RESOLVERESOLVE Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40
  24. 24.  ADAPTATIONADAPTATION  Capability of family to utilize & share inherent resourcesCapability of family to utilize & share inherent resources (intra/extra-familial)(intra/extra-familial)  PARTNERSHIPPARTNERSHIP  Sharing of decision-making; measures satisfaction attained inSharing of decision-making; measures satisfaction attained in solving problems by communicatingsolving problems by communicating  GROWTHGROWTH  Physical & emotional growth; measures satisfaction ofPhysical & emotional growth; measures satisfaction of available freedom to changeavailable freedom to change  AFFECTIONAFFECTION  How love, anger, hatred are shared between members;How love, anger, hatred are shared between members; measures members’ satisfaction with intimacy & emotionalmeasures members’ satisfaction with intimacy & emotional interaction existing in the familyinteraction existing in the family  RESOLVERESOLVE  How time, money, space are shared; measures membersHow time, money, space are shared; measures members satisfaction with commitment by other members of familysatisfaction with commitment by other members of family Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40
  25. 25. When is Family APGARWhen is Family APGAR needed?needed? 1.1. When family is directly involved in caringWhen family is directly involved in caring for the patientfor the patient 2.2. When treating a new patient in order toWhen treating a new patient in order to serve as general view of family functionserve as general view of family function 3.3. When treating a patient whose family isWhen treating a patient whose family is in crisisin crisis 4.4. When patient’s behavior makes youWhen patient’s behavior makes you suspect a psychosocial problem possiblesuspect a psychosocial problem possible due to family dysfunctiondue to family dysfunction Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.40
  26. 26. ALMOSTALMOST ALWAYSALWAYS Score = 2Score = 2 SOME OFSOME OF THE TIMETHE TIME Score = 1Score = 1 HARDLYHARDLY EVEREVER Score = 0Score = 0 AA I amsatisfied that I can turnI amsatisfied that I can turn my family forhelp whenmy family forhelp when something is troubling mesomething is troubling me PP I amsatisfied with the wayI amsatisfied with the way my family talks on things withmy family talks on things with me & shares problems withme & shares problems with meme GG I amsatisfied that my familyI amsatisfied that my family accepts & supports my wishesaccepts & supports my wishes to take on new activities orto take on new activities or directiondirection AA I amsatisfied with the wayI amsatisfied with the way my family expresses affectionmy family expresses affection & responds to my emotion& responds to my emotion such as anger, sorrow & lovesuch as anger, sorrow & love RR I amsatisfied with the wayI amsatisfied with the way my family and I share timemy family and I share time togethertogether Parameters
  27. 27.  SCORING:SCORING: 8 – 108 – 10 HIGHLY FUNCTIONALHIGHLY FUNCTIONAL 4 – 74 – 7MODERATELY DYSFUNCTIONALMODERATELY DYSFUNCTIONAL 0 – 30 – 3 SEVERELY DYSFUNCTIONALSEVERELY DYSFUNCTIONAL Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.41
  28. 28. CLINICALCLINICAL BIOGRAPHY &BIOGRAPHY & LLIFEIFE EVENTSEVENTS  Valuable tools which can facilitate analysisValuable tools which can facilitate analysis of connectionof connection  Individual’s experiences with health andIndividual’s experiences with health and sickness are connected with his personalsickness are connected with his personal lifelife Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48
  29. 29. Example (taken from “Daffodil” case presentation)Example (taken from “Daffodil” case presentation) 1982 - Childhood years1982 - Childhood years 1983 - Sibling Rivalry1983 - Sibling Rivalry 1990 - “ First love”1990 - “ First love” - Financial Difficulties- Financial Difficulties 1992 - Sexually Violated1992 - Sexually Violated 19971997 - Met Bobby- Met Bobby Common-law relationshipCommon-law relationship 1999 - 21999 - 2ndnd pregnancypregnancy 2000 - 32000 - 3rdrd pregnancypregnancy - Resignation of Bobby- Resignation of Bobby 2001 - “Guest Relations Officer”2001 - “Guest Relations Officer” 2002 - “New boyfriend”2002 - “New boyfriend”  44thth pregnancypregnancy 2004 - 52004 - 5thth pregnancypregnancy - Reconciliation with Bobby- Reconciliation with Bobby 2005 - Financial problems2005 - Financial problems 2006 - Vaginal bleeding2006 - Vaginal bleeding - Hospitalized- Hospitalized  Cervical CancerCervical Cancer
  30. 30. SCREEMSCREEM  Important as to assess family’sImportant as to assess family’s capacity to participate incapacity to participate in provision of health care and itsprovision of health care and its capacity to cope with crisiscapacity to cope with crisis Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48
  31. 31. SCREEMSCREEM RESOURCERESOURCE SSOCIALOCIAL Social interaction is evident among family members. FamilySocial interaction is evident among family members. Family members have well-balanced lines of communication with extra-members have well-balanced lines of communication with extra- familial social groups.familial social groups. CCULTURALULTURAL Cultural pride orsatisfaction can be identified, especially inCultural pride orsatisfaction can be identified, especially in distinct ethnic groups.distinct ethnic groups. RRELIGIOUSELIGIOUS Religion offers satisfying spiritual experiences as well as contactsReligion offers satisfying spiritual experiences as well as contacts with an extra-familial support group.with an extra-familial support group. EECONOMICCONOMIC Economic stability is sufficient to provide both reasonableEconomic stability is sufficient to provide both reasonable satisfaction with financial status and an ability to meet economicsatisfaction with financial status and an ability to meet economic demands of normative life events.demands of normative life events. EEDUCATIONADUCATIONA LL Education of family members is adequate to allow members toEducation of family members is adequate to allow members to solve orcomprehend most of the problems that arise within thesolve orcomprehend most of the problems that arise within the format of the life style established by the familyformat of the life style established by the family MMEDICALEDICAL Health care is available through channels that are easily establishedHealth care is available through channels that are easily established and have previously been experienced in a satisfactory mannerand have previously been experienced in a satisfactory manner Pineda, Alejandro Jr.. Proceedings of the Orientation Course in Family Medicine.p.48
  • RobertNnamchi

    Jan. 22, 2021
  • MarkAnthonyArombo1

    Dec. 7, 2018
  • WikiChew

    Apr. 6, 2018
  • ObeleIsraelYAbalaku

    Mar. 14, 2018
  • sarakhader3

    Feb. 26, 2018
  • NamgyalTashi

    Nov. 6, 2017
  • blesschuks

    Jul. 23, 2017
  • reyan_md

    Jun. 28, 2017
  • SahanaBhat10

    Oct. 21, 2016
  • javie1101

    Apr. 4, 2016
  • tamaratrent

    Jul. 7, 2015
  • zheichua

    Feb. 4, 2014

Views

Total views

7,456

On Slideshare

0

From embeds

0

Number of embeds

7

Actions

Downloads

611

Shares

0

Comments

0

Likes

12

×