TOOLS IN FAMILY HEALTH ASSESSMENT

FAMILY HEALTH
ASSESSMENT TOOLS
BY: ROMMEL LUIS C. ISRAEL III
BY: ROMMEL LUIS C. ISRAEL III 1

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

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

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
Me
Mama Pesh
Mama
chuchi
Chok
Ja Kuya Nel
Dex
Arra
Erin Ate Tere
Rihanne

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
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.

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.

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

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
-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

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

TOOLS IN FAMILY HEALTH ASSESSMENT

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