The document discusses various family models and evaluation processes, emphasizing their roles in understanding family dynamics, development, and health. It outlines the importance of family evaluation tools in promoting health and wellbeing, detailing models such as Friedman’s structural-functional model, Duvall’s family life cycle, and Bowen’s family systems theory. The document highlights stages of family development from the beginning stages to middle-aged parents, including the developmental tasks and health care concerns associated with each stage.

1. EVALUATING THE FAMILY – THE FAMILY
MODELS
DR OGECHUKWU MBANU
DEPARTMENT OF FAMILY MEDICINE
AKTH KANO NIGERIA
11 / 4 / 18

2. Pre test
The stage of the family life cycles are defined by
Duvall in terms of
A. The age and school placement of the oldest
child
B. The ages of the parents
C. The age of the middle child
D. Years of marriage

3. 2 ) Regarding family development
A.Friedman family model
B.Calgary model
C.Duval developemental model
D.Systems model
E.Stevensons model

4. •3) satir’s model of healthy family consists of
the following except
A.Self-worth
B.Confidence
C.Communication
D.Roles
E.Links to the society

5. •4) Friedman structural – functional model
A.Family structure
B.Family function
C.Environmental data
D.Developmental stage
E.All of the above

6. •5) family functions are
A.Affective
B.Socialization
C.Reproduction
D.Economic
E.All of the above

7. OUTLINE
•Introduction
•The family
•Family model
•Importance of family evaluation
•Family evaluation tools
•Types of family model
•Indications for family evaluation
•Conclusion
•References

8. INTRODUCTION
•Family evaluation is the process of gaining insight
into the family’s world,their goals ,needs ,concerns
,their strengths and support net works
•The aim is to improve the health and wellbeing of
the family
•Process of collecting data systematically using
predetermined guidelines and then classifying and
analyzing the data so as to make diagnoses with
goals and interventions for care created in
collaboration with the patient and family members

9. THE FAMILY
• That group of individuals who are related to a patient biologically,
legally or by choice , from whom the patient can reasonably expect a
measure of support in the form of food, shelter, finance and emotional
nurturing and that share a past, present and a future.
• A group of people who are closely related by birth, marriage or
adoption.
• An organization or social institution with continuity, having a past,
present and future, in which there are certain behaviors in common that
affect each other
• Types of family include :nuclear ,single parent ,blended or reconstituted
,cohabiting , gay / lesbian family, patriarchal /patrilocal /patrilineal
/Patricentric ( consider the opposite) ,neolocal

10. THE FAMILY CONT’D – FUNCTIONS OF THE FAMILY
• Physical maintenance – shelter, clothing, food, and health care.
• Division of labour - family members decide who will assume what
responsibilities, such as providing income
• Reproduction
• Placement of members in the larger society-.
• Provide protection from hostile forces
• Families pass on culture ,including faith
• Maintenance Of order - order is maintained by the communication of
acceptable behavior.
• DYSFUNCTIONAL FAMILY :-defined as a family with chronic inability to
respond to the needs or to cope with changes and stresses within the family
and its environment

11. FAMILY MODEL
•These are set standards of families which serve as basis or
guidelines for evaluating different aspects of the family
institution
•No model can capture fully all the dimensions of a family’s
experience
•Family model is seen as a family evaluation tool but some
models also make use of the other tools in to properly
evaluate the family
•Family evaluation - used by family physicians , psychologists
psychiatrists , family therapists ,nurses ,social workers

12. IMPORTANCE OF FAMILY EVALUATION
•It helps the doctor understand the family's perspective of
things
•The family is a unit of care and each member has
responsibility for others
•Helps the doctor to promote development and
maintenance of health for all
•Dysfunction in a family member affects others, increases
stress and decreases resources
•Collaborating with families to develop useful interventions

13. FAMILY EVALUATION TOOLS
ANATOMY
• Genogram
DEVELOPMENT
• Family life cycle
• Family spiral
FUNCTION
• APGAR
• Family Map
• Lifeline
• Ecomap ,etc
RESOURCES
• FACES
• SCREEM

14. TYPES OF FAMILY MODEL
Developmental
model
• Duval’s
family life
cycle
• Stevenson's
• Carter and
McGoldricks
Structural -
functional
• Friedman
Interactional
•Satir
•Calgary
Systems
model
• BOWENS

15. STEVENSON’S FAMILY DEVELOPMENT MODEL
•Joanne Stevenson(1977)
• Applies more to nuclear families
•family structure is not evaluated
•Does not address health promotion and health –
related concerns
•There are Four stages
•Stages are delineated by the number of years the
couple are married and their approximate age

16. STEVENSON’S FAMILY DEVELOPMENT MODEL
•basic tasks and responsibilities of families into four
stages:
• maintaining a common household,
• rearing children,
• and finding satisfying work and leisure
•Tasks also extended to include
•sustaining appropriate health patterns
•providing mutual support
•acculturation of family members.

17. STEVENSON’S FAMILY DEVELOPMENT MODEL CONT’D

18. SATIR’S INTERACTIONAL FAMILY MODEL
• Healthy families help their members know themselves through communication
of everyday events
• This communication promotes each individual’s self-esteem and self-worth
• Satir’s model of the healthy family consists of four concepts
• self-worth
• Communication
• roles
• links to society – the ecomap can be used
• Desired communication stance is the congruent stance
• Other communication stances eg blamer ,placator ,supper-reasonable ,
irrelevant are maladaptive
• Roles e.g. the martyr ,the victim ,the rescuer ,the good child / parent ,the bad
child / parent should be explored

19. FAMILY SYSTEMS THEORY
• Developed from THE GENERAL SYSTEMS THEORY proposed by Ludwig Von
Bertalanffy(1968) which describes the principle that govern all living
systems
• A system is viewed as being
- self regulatory
- having self correcting feedbacks
- functions in same way
- parts have functional and structural relationships with each other
• The interrelationship in a family system are closely tied
• Change in one part results in change in the other
• The main components of family systems theory are BOUNDARIES,RULES
,ROLES , HIERARCHY ,CLIMATE , EQUILIBRIUM (adaptability) .

20. BOWENS FAMILY SYSTEMS THEORY
•Also known as Bowen Natural Systems Theory,
describes the natural emotional processes which
shape how families and other social groups
function.
•Built from study of the human family as a living,
natural system.
• Whole is greater than sum of its parts
•A change in one part part of the system can impact
change in the entire system

21. BOWENS FAILY SYSTEMS THEORY
•Four background concepts and assumptions:
• CHRONIC ANXIETY
• BASIC LIFE FORCES
•EMOTIONAL PROCESS
• THE FAMILY AS AN EMOTIONAL UNIT.

22. FOUR BACKGROUND CONCEPTS AND ASSUMPTIONS
•CHRONIC ANXIETY - Anxiety is an organism's response to
a real or imagined threat.
•All living things experience anxiety in some form
• Chronic anxiety differs from acute anxiety.
• Acute anxiety is usually a response to a real threat and is
of short duration.
• Chronic anxiety is ordinarily a response to an imagined
threat and has a more enduring quality
• family members may react more to the disturbance in
the relationship system than to the events themselves

23. four background concepts and assumptions cont’d
•BASIC LIFE FORCES - Bowen defined two life forces at work in
human relationship systems ie :
• TOGETHERNESS AND
• INDIVIDUALITY
• Togetherness :- pressure and desire to be like others, to agree on
beliefs, principles, values, and feelings
• Individuality or differentiating force :- impetus to define a separate
self from others
• Differentiating force is responsible for self without making demands
on others
• the togetherness force assumes responsibility for the happiness,
comfort, and well-being of others

24. four background concepts and assumptions cont’d
The Family as an Emotional Unit
•Family is seen as one organism.
• Pathology in a member of the family is a symptom
of imbalance in the family emotional system
•Symptoms can fall into : physical, emotional, and
social dysfunction.
•Eg , developing cancer, getting depressed, or
committing a crime, would each be conceptualized
as symptoms of emotional process in the family.

25. four background concepts and assumptions cont’d
EMOTIONAL SYSTEM - Bowen distinguished between
emotions and feelings
•Feelings can be felt while emotions operate outside of
awareness
•Feelings like joy, despair, anger, or guilt, may be a
surface awareness of emotions
•There is thinking influenced by the feeling and
emotional system and
•thinking which is independent of feeling and
emotions(objective thinking)

26. EIGHT INTERLOCKING CONCEPTS OF BOWEN THEORY
•Differentiation of self
•Triangles
•Nuclear family emotional process
•Family projection process
•Cutoff
•Multigenerational transmission process
•Sibling position
•Societal emotional Process

27. DIFFERENTIATION OF SELF
•solid self, the part of self that is not negotiable in
relationships.
•Ability to think and act for self
•At higher levels of differentiation, people maintain separate,
solid selves under considerable stress and anxiety
• At lower levels of differentiation, people depend on others
to function, and they develop significant symptoms under
stress
• The opposite of differentiation is fusion – mercy of
emotional reactions & become anxious at low levels of stress
(fusion differentiation scale)

28. TRIANGLES
• A two-person system (dyad) becomes unstable once
anxiety increases
• third person may be pulled in to relieve some of the
pressure
•In a three-person system, anxiety has more release
therefore more relief
•If anxiety is not contained, more people are involved and
forms a series of interlocking triangles.
• if one member of the triangle remains calm the system
automatically calms down or members lock into a
triangular position, and develop symptoms

30. NUCLEAR FAMILY EMOTIONAL PROCESS
•People choose mates with similar levels of differentiation
•Poorly differentiated marital dyad will become highly
fused
•When highly fused, three possible resulting symptomatic
patterns will develop
• physical emotional dysfunction in a parent
• marital conflict (cycles of emotional distance vs. over
closeness)
• psychological impairment in child (parents overly focused on
child)

31. FAMILY PROJECTION PROCESS
•Some parents may focus anxiety or their
relationship issue on a child and the child
develops problems.
• Parents then usually attempt to get the child to
change or they ask an expert to "fix" the child

32. EMOTIONAL CUTOFF
•There is extreme distancing posture
•family members discontinue emotional contact with
each other
•People look for other relationships to substitute for
the cut off relationship (as a way to cope with
unresolved fusion and anxiety)
•Bowen contended that adults must resolve their
emotional attachments to their families of origin

33. MULTIGENERATIONAL TRANSMISSION PROCESS
•Degrees of differentiation transmitted over several
generations
•If the least well differentiated members of two families
marry, then the offspring may have even lower
differentiation levels
•These people are vulnerable to anxiety & fusion

34. SIBLING POSITION
•Oldest, youngest, and middle children tend toward
certain functional roles in families
SOCIETAL EMOTIONAL PROCESS
•It refers to the tendency of people within a society to be
more anxious and unstable at certain times than others

35. FRIEDMAN STRUCTURAL – FUNCTIONAL MODEL
•Introduced by TALCOTT PARSONS (1951) and later applied
to family nursing by FRIEDMAN etal (1986)
•The family is viewed a basic unit of the wider society ie a
subsystem within the society
•The main focus is family structure and functions and the
family’s relationship with supra- systems in the
community e.g. Religious organizations education and
health

36. FRIEDMAN STRUCTURAL – FUNCTIONAL MODEL CONT’D
•The model has six broad categories for
evaluation namely ;-
•Family structure
•Family function
•Environmental data
•Developmental stage
•Identification data
•Family coping patterns

37. FRIEDMAN EVALUATION CATEGORIES
FAMILY IDENTIFYING DATA
• Family last name
• Family composition – a genogram is used
• Racial / Ethnic background
• Religious identification
• Social class status
ENVIRONMENTAL DATA
•Evaluated with the following elements
•Characteristics of home
•Neighborhood and larger community
•Family’s social support system

38. FRIEDMAN EVALUATION CATEGORIES
FAMILY STRUCTURE - The way the family is arranged , the units are
organized and how all these units link to each order
• how well it fulfills its functions and the goals important to its members
and the society
• should serve to facilitate the achievement of the functions of the family
• Family structure is evaluated based on the following elements
• Communication
• Roles
• Power structure
• Values
• The doctor must identify the individuals that make up the family , the
relationships between the family and other social system

39. PATERNS OF COMMUNICATION

40. FRIEDMAN EVALUATION CATEGORIES cont’d
FAMILY FUNCTION
•five main elements of family function evaluated are
•Affective
•Socialization and social placement
•Reproduction
•Economic
•Healthcare / physical necessity
DEVELOPMENTAL STAGE AND HISTORY OF THE FAMILY
•Duval’s developmental staging is applied

41. FRIEDMAN EVALUATION CATEGORIES cont’d
FAMILY COPING PATTERNS
•Factors to be considered are
•Current stressors
•Coping strategies used
•Dysfunctional adaptive strategies used
•Problem areas in which family has achieved
mastery
•Some tools that can be used to help us get the facts
includes- family mapping ,genogram ,ecomap

42. DUVALLS FAMILY LIFE CYCLE
•Family life cycle is a dynamic process of change that
occurs in a family involving stages of development which
reflect the biological functions of raising children
•The family life cycle describes family life overtime as
comprising series of stages and transitions
•A family stage is an interval of time in which the
structure and interaction of role relationships in the
family are qualitatively and quantitatively distinct from
other periods

43. THE BEGINNING FAMILY

44. Stages I -- The Beginning Families
•This is the stage of marriage.
•marks the beginning of a new family with the movement
from the former family of origin to the new intimate
relationship.
•Developmental Task
• Establishing a mutually satisfying marriage.
•Relating harmoniously to the kin network.
•Planning a family – Decisions about parenthood.

45. STAGES I -- THE BEGINNING FAMILIES CONT’D
HEALTH CARE CONCERNS
•Family planning education and counseling.
•Pre-natal education and counseling.
• Sexual and marital role adjustment.
•Lack of information often results in sexual and
emotional problems, fear, guilt feelings, unplanned
pregnancies and veneral disease either before or
after marriage

46. STAGE II -- CHILD BEARING FAMILY
•Stage II begins with the birth of the first child and continues
through the infants 30th month

47. STAGE II -- CHILD BEARING FAMILY
DEVELOPMENTAL TASKS
•Setting up the young family as a stable unit. This
involves integrating of the new baby into the family.
•Reconciling conflicting developmental tasks and needs of
various family members.
•Maintaining a satisfying marital relationship.
•Expanding relationships with extended family by adding
parenting and grand parenting roles.

48. STAGE II -- CHILD BEARING FAMILY CONT’D
HEALTH CARE CONCERNS
•Issues related with pregnancy
e.g. Morning sickness, PIH
• Preparation for birth
experiences.
• Infant care.
• Prompt recognition and
appropriate handling of
physical health problems with
the child
• Immunizations.
•Normal growth and
development.
• Safety measures
• Family planning
• Good health practices
(sleep, nutrition, exercise

49. STAGE III – FAMILIES WITH PRESCHOOL CHILDREN
•Commences when the first born child is about 2½ years old
and terminates when he or she is 5 years
of age.
•Consist of three to five persons with
paired positions of husband-father,
wife-mother, son-brother,
daughter-sister

50. FAMILY DEVELOPMENTAL TASKS
•Socializing the children
•Integrating new child members while still meeting
needs of other children
•Maintaining healthy relationship within the family
(marital and parent-child)and outside the family
(extended family and community)
•Meeting family members needs for adequate
housing , space, privacy and safety

51. HEALTH CARE CONCERNS
• Accident prevention and home safety (e.G falls, burns, poisoning)
• Sibling relationships
• Family planning
• Communicable diseases of children
• Growth and development needs
• Parenting issues
• Child abuse and neglect
• Good health practices (e.G sleep, nutrition, exercise,)
• Home safety
• Family communication problems

52. STAGE IV
FAMILIES WITH SCHOOL- AGED CHILDREN
•When the first born child enters school fulltime
usually at the age of 5 years to
when he or she reaches puberty
( around 13 years of age)
•Peer relationships and outside
activities play larger roles in
the school aged child

53. DEVELOPMENTAL TASK
•Socializing the children, including promoting school
achievement and fostering of healthy peer relations
of children.
• Maintaining a satisfying mental relationship
•Meeting the physical health needs of family
members.
•Learning to deal with the child's separation or more
simply letting the child go

54. HEALTH CARE CONCERN
•Health challenges to children (e.G. Vision, hearing ,
speech.)
• Dental health
•Child abuse and neglect
• Substance abuse
•Communicable diseases
• Chronic conditions
•Behavior problems
• Good health practices

55. STAGE V -- FAMILIES WITH TEENAGERS
•Starts when the firstborn turns 13years of age and usually last
about six to seven years,
•Challenges in working with a family at this stage revolves
around the mental and
hormonal changes adolescents
go through
•Cognitive changes , identity
formation and biological
growth

56. DEVELOPMENTAL TASKS
•Balancing of freedom with
responsibility
• Refocusing the marital
relationship
•Communicating openly
between parents and
children
•Maintaining the families
ethical and moral standard.
HEALTH CARE CONCERNS
• Accidents
•Sports injuries
•Drug and alcohol misuse
• Sex education
•Unexpected pregnancies
•Marital relationship
•Adolescent parent
relationship
•Good health practices.

57. STAGE VI - FAMILIES LAUNCHING YOUNG ADULTS
• begins when the first child leaves home and ends when the last child has
left home
• Usual length is six to seven years
• More older children living at home after schooling and starting working
usually due to economic reason thus prolonging the stage
• Grandparent roles starts , which creates changes in roles and self image
the
• “caught” period of life
• Caught between the demands of youth / expectations of the elderly and
between the world of work /demands of the family
• Stage of menopause and andropause / middlescence

58. DEVEVELOPMENTAL TASK
• Expanding the family circle to
include new family members
acquired by marriage
• Continuing to renew and readjust
in the marital relationships
• Assisting aging and ill parents of
the husband and wife
HEALTHCARE
CONCERNS
• Role transitional problems for
husband and wife
• Emergence of chronic health
problems
• Family planning for young adults
• Menopausal /andropause
• Effects of prolonged drinking,
smoking and poor dietary
practices
• Wellness lifestyles
• Preventive medical screening for
some diseases

59. STAGE VII - MIDDLE AGED PARENTS
•when the last child leaves home -- “empty nest” and ends with
retirement or death of one of the spouses
•The “plateau phenomenon”
• Salaries and promotions may no longer be available , leading to
feelings of discontentment, boredom and stagnation
•Feelings of vulnerability to illness generated when friend
/family members of same age group has health challenges eg
heart attack, stroke or cancer
•“generational squeeze” – many women find themselves in a
generational squeeze as they attempts to balance the needs of
their aging, frail or ill parents, their children and grand children

60. DEVELOPMENTAL TASK
• Providing a health-promoting environment
• Sustaining satisfying and meaningful relationships
with aging parents and children
• Strengthening the marital
relationship
•Accepting and welcoming
grandchildren into the
family

61. HEALTH CARE CONCERNS
• Promoting good health
practices such as adequate rest
, leisure activities, good
nutrition, regular exercise,
cessation of smoking,
reduction/ cessation of alcohol
• Maintaining good marital
relationships
• Communicating with and
relating to children , in-laws,
grand children and aging
parents.
• Care giving issues and
concerns
• social isolation and financial
difficulties
• Adjustment to physiological
changes of aging
• Coping with emergence of
chronic illness eg. Arthritis,
HTN, obesity
• Preventive health screening –
prostrate CA, colorectal CA,
breast CA

62. STAGE VIII - FAMILIES IN RETIREMENT AND OLD AGE
• Cycle begins with the retirement of one or both spouses, continues
through the loss of one spouse and ends with the death of the other
spouse
• Perception of this stage has a lot to do with financial resources and
health status
• Loss of independence due to ill health lead to low morale, behavioral
and psychological problems
• Loses common to aging
people include economic
status, housing ,
family members
and friends ,health

63. DEVELOPMENTAL TASKS
• Maintaining a satisfying living
arrangement
• Adjusting to a reduced income
• Maintaining marital
relationship
• Adjusting to loss of spouse
• Maintaining intergenerational
family ties
• Continuing to make sense out
one’s existence (life review and
integration
HEALTH CARE CONCERN
• Increasing functional
disabilities
• Mobility impairment
• Chronic illness
• Diminished physical vigor and
function
• Long term care services
• Social isolation
• Grief / depression
• Cognitive impairment

64. DUVALLS FAMILY LIFE CYCLE CONT’D
•In this developmental model evaluation the doctor
should
•Name the developmental stage of the family
•Document the extent to which the family is fulfilling
the developmental tasks
•Nuclear family history
•History of family of origin
•Health care concerns not met
•A genogram is drawn and has to include the parents
families of origin

65. CALGARY FAMILY MODEL
•Calgary family model evaluates the
•Structural
•Developmental
•Functional aspects of the family
•The genogram and the ecomap are used in this
evaluation model
•The developmental model used is the CARTER AND
McGoldricks developemental model
•Usually used alongside the Calgary family intervention
model(CFIM)

66. CALGARY FAMILY MODEL cont’d
•Internal structure
•External structure
•context
Structural
•Carter and McGoldrick
developmental model
Developmental
•Instrumental
•Expressive
Functional

67. STRUCTURAL
• Family composition
• GenderInternal structure
(6 categories)
•Extended family -- a genogram is used
•The larger system – ecomap is applied
here
External structure
(2 sub-categories)
Context (5 sub-
categories)
Family composition Rank order
Gender Subsystems
Sexual orientation Boundaries
Ethnicity Spirituality
Race Environment
Social class

68. FUNCTIONAL ASPECT
• refers to routine activities of daily living
such as eating, sleeping, preparing
meals, giving medications
• Crucial interactions amongst family
members
Instrumental
functioning
Expressive
functioning
(9 sub-
categories)
Emotional
communication
Circular
communication
Inluences and
power
Verbal
communication
Problem solving beliefs
Nonverbal
communication
roles Alliances and
coalitions

69. DEVELOPMENTAL ASPECT
•Carter and McGoldrick dev. Model is used
•Developed in 1985 is one of the modifications of Duvall's
developmental model
•Unlike the Duvall's it recognizes single adults , divorced families
,remarriage and domestic partners
•The model has six stages of family cycle namely:-
1. Leaving home - single adult
2. Joining of families - usually through marriage – the new couple
3. Families with young children
4. Families with adolescents
5. Launching children and moving on
6. Families in later life

70. CALGARY FAMILY EVALUATION MODEL CONT’D
•After obtaining the above data then the doctor
goes further to analyze all the information
•Assessment summary
•Family strengths and weaknesses
•Family diagnosis
•Family comparisons
•Family care plan – To include GOALS and
INTERVENTION or plan for achieving the goals

71. SIGNS INDICATING THE NEED FOR FAMILY EVALUATION
•Nonspecific symptoms in a patient who visits
frequently: - particularly in the absence of organic
disease.
•Over utilization of medical care services or frequent
visits by different family members
• Difficulty in the management of chronic illness
•The “Ripple Effect” : - when one member of the family
presents with the same symptoms of a serious illness or
crisis as another member, or a series of illnesses occur
in close sequence within the family

72. INDICATIONS FOR FAMILY EVALUATION CONT’D
• Emotional and behavioral problems, such as “acting out” in the
adolescent, depression, or anxiety in the adult
• suicidal tendency
• Marital and sexual problems
• Diseases causally related to lifestyles and environmental factors
(liver disease and alcoholism, lung disease and smoking, peptic
ulcer and emotional stress) .
• Loss of a family member, loss of home or employment,
disfigurement or amputation by accident, family violence , child
abuse or neglect, separation

73. CONCLUSION
•The overall purpose of family evaluation for the family
physician is to help improve the health of the family
•Family health can be affected by biological ,
psychological , sociological ,cultural and spiritual factors
•The use of family models helps the doctor look into
these factors with the aims of
•Health promotion
•Health maintenance
•Disease prevention
•Illness management

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