This document discusses assessing the family as a unit of care using various tools and models. It describes the family life cycle model which views the family as progressing through different stages of development with associated tasks. The genogram is introduced as a tool to visually map family connections and identify patterns. Key areas of family function are outlined including biological, economic, educational, psychological, and socio-cultural roles. The document emphasizes examining biopsychosocial factors and assessing the family's strengths when evaluating health, illness, and care decisions.

1. THE FAMILY AS A UNIT OF CARE Aileen B. Pascual, MD, DPAFP 10 July 2010

2. The Biopsychosocial Approach PSYCHOLOGICAL SOCIAL HEALTHILLNESS BIOLOGICAL

3. BIOSPHERE SOCIETY-NATION CULTURE-SUBCULTURE COMMUNITY FAMILY PERSON SYSTEM ORGAN TISSUE CELL ORGANELLE MOLE CULE

4. BIOSPHERE SYSTEM SOCIETY-NATION ORGANS CULTURE-SUBCULTURE TISSUES COMMUNITY CELLS FAMILY ORGANELLES TWO-PERSON MOLECULES PERSONAL (EXPERIENCE & BEHAVIOR) ATOMS SUBATOMIC Engel’s Hierarchy of Systems

5. COMMUNITY FAMILY PERSON

6. POSSIBLE DISEASE BIO-PSYCHO-SOCIAL DATA BIOMEDICALA Medical History Physical Examination Diagnostic Tests Psychosocial issues and health beliefs Impact of illness Family assessment

7. The Family

8. SHARED FUTURE SHARED PAST

9. Definition Genetic transmission unit Matrix of personality of development and the most intimate emotional unit of society Enduring social form in which a person is incorporated

10. Classification according to Structure

11. NUCLEAR FAMILY Parents, dependent children Separate dwelling not shared with members of the family of origin/orientation of either spouse Economically independent

12. EXTENDED FAMILY Unilaterally extended Bilaterally extended Includes 3 generations Lives together as a group Kinship network provides function to all members

13. SINGLE PARENT FAMILY Children < 17 years of age, living in a family unit with a single parent, another relative or non-relative May result from: Loss of spouse by death, divorce, separation, desertion Out of wedlock birth of a child From adoption Migration (OFWs)

14. BLENDED FAMILY Includes step-parents and step-children Caused by divorce, annulment with remarriage and separation

15. COMMUNAL FAMILY Grouping of individuals which are formed for specific ideological or societal purposes Considered as an alternative lifestyle for people who feel alienated from the economically privileged society Vary within social context

16. The Filipino Family

17. The Filipino Family Closely knit Bilaterally extended Authority based seniority/age Externally patriarchal, internally matriarchal High value on education of members

18. The Filipino Family Predominantly Catholic Child-centered Average number of members is 5 Environmental Stresses: Economic Political Urbanization Industrialization Health problems

19. Attributes & Characteristics

20. The Family as a Very Special Unit Lifelong involvement Shared attributes Genetics – physical and psychological Developmental – shared home, lifestyle, social activities Sense of belonging Security/defense against a potentially hostile environment Companionship

21. The Family as a Very Special Unit Societal expectations Sense of responsibility towards members & others Basis of affection/care Built-in problems Generation gap Dependence of members Emotional attachment/involvement The family endures in spite of problems Resource utilization Authority Individual sense of responsibility

22. Family Strengths The ability to provide for the family’s needs: Physical - space management, balanced meals, general health status Emotional - helping family members recognize and develop their capacity for sensitivity for each other’s needs Spiritual/Cultural – sharing of basic beliefs and cultural values

23. Family Strengths Child-rearing practices & discipline: Capacity of parents to respect each others’ views and decisions on child-rearing practices Capacity of single parent to be consistent and effective in raising children

24. Family Strengths Communication Ability to communicate and express a wide range of emotions and feelings both actively and non-verbally Support, Security and Encouragement Capacity of the family to provide its members with feelings of security and encouragement Balance in pattern of family activities

25. Family Strengths Responsible Community Relationships Capacity of family members to assume responsibility through participation in social, cultural or community activities Self-Help and Accepting Help Ability of family members to seek and accept help when they need it

26. Family Strengths Flexibility of family function and roles Ability to “fill in” of one member for another during times of illness of when needed Crisis as a means of growth Ability to unite and become supportive during a crisis or traumatic experience

27. Family Strengths Family unity, loyalty and intra-familial cooperation Ability to recognize and use family traditions and rituals that promote unity and pride

28. Why study the Family ?

29. Transmission of infectious disease Health behavior is acquired from the family

30. Psychosocial stress can occur within the family Source of social support

31. Defines health and illness Makes health decisions

32. Cause of illness or problem Resource for prevention or cure; solution of the problem

33. Basic Areas of Function Biologic Reproduction Child-rearing/Caring Nutrition Health maintenance Recreation Economic Provision of adequate financial resources Resource allocation Ensure financial security

34. Basic Areas of Function Educational Teach skills, attitudes and skills relating to other functions Psychologic/Affection Promotes the natural development of personalities Offer optimum psychological protection Promotes ability to form relationships with people within the family circle Socio-Cultural Socialization of children Promotion of status and legitimacy

35. POSSIBLE DISEASE BIO-PSYCHO-SOCIAL DATA BIOMEDICALA Medical History Physical Examination Diagnostic Tests Psychosocial issues and health beliefs Impact of illness Family assessment

36. Family Assessment Tools Function APGAR Family Map Lifeline SCREEM Development Family Life Cycle Anatomy Genogram

37. Family Anatomy Genogram

38. Genogram Visual map of connections among family members “pedigree”

39. Genogram Includes the following: Names Ages Marital status Former marriages Children Households, significant illnesses Dates of traumatic events (death) Occupations

40. Genogram May reveal transgenerational family patterns, dysfunctional emotional patterns, or common medical problems

41. How to Construct a Family Genogram Each generation is identified by a Roman numeral The firstborn of each generation is farthest to the left, with siblings following to the right, in order of birth If the children have spouses, connect the spouse to them using a horizontal line If they have children, connect the children to them using a vertical line

42. How to Construct a Family Genogram The family name is placed above each major family unit Given names and ages are placed below each symbol One member of the family is of greater medical significance because of an illness and gets to become known as the INDEX patient; and is identified with an arrow Date when the chart was developed so ages can be adjusted

43. Persons living in the same household are enclosed with a heavy line Significant diseases in the family can be illustrated using symbols which should appear in the legend Death including date and cause is illustrated with a slash line Dates of marriages and separation are indicated How to Construct a Family Genogram

44. Genogram Symbols Male Female Unknown sex Pregnancy Induced abortion Spontaneous abortion Index patient, Name, Age Bert, 5 Jane, 12 May,29 Roy, 50

45. Genogram Symbols Dizygotic Twins Daughter Son Monozygotic Twins Unknown sex of child A Adopted

46. 2008 2008 2008 Genogram Symbols Death And Cause RHD Stroke Pneumonia MI Not married and Year started living together Marriage and Year 2008 Separation and Year Divorce and Year

47. 1990 Genogram Symbols Individuals living together

48. 1990 Genogram Symbols Marital Discord

49. FAMILY GENOGRAMGALMAN- AQUILINO FamilyAPRIL 11, 2009 AQUILINO GALMAN A RUEL , 65 MARTHA, 62 KYLA, 19 KEVIN 29 Legend PNEUMONIA ASTHMA

50. Genogram Samples E. Family Bulacan 2010 Joseph, 35 Alice, 33 Beth, 2 May, 5

51. Family Assessment Tools Function APGAR Family Map Lifeline SCREEM Development Family Life Cycle Anatomy Genogram

52. Family DevelopmentFamily Life Cycle

53. Family Life Cycle Assess a patient and family developmental concerns Identifies stages of family development that reflect the biological functions of raising children As the family system moves together through time, the individual life cycles intertwines with the life cycles of other family members

54. Family Life Cycle This connection among generations reflects oscillation of the family system from developmental periods of family closeness (centripetal) to periods of relative distance (centrifugal). When illness occurs during a centripetal period, the family may be more easily mobilized to care for the ill member than it is during a centrifugal period.

55. Life Cycle Stages Families go through different stages for which specific developmental tasks must be accomplished. Families who are not able to accomplish these tasks may develop difficulties with subsequent family development.

56. Family Life Cycle

57. Family Assessment Tools Function APGAR Family Map Lifeline SCREEM Development Family Life Cycle Anatomy Genogram